Validation of the PHNs precepting experiential learning causal model for preceptors of novice public health nurses in Japan

Aims

The purpose of this study was to analyse the relationship among public health nurse (PHN) precepting experiential learning (PHN-PEL) and the outcomes.

Background

The government supported PHNs' systematic career development and precepting learners.

Design

A nationwide questionnaire survey was conducted for PHNs who precepted novice PHNs in governmental units from 2012 to 2015.

Methods

"PHN Precepting Experiential Learning Scale," "Professional Development for Public Health Nurses" and "Awareness of Responsibility for Organization" were examined through structural equation modelling.

Results

Usable responses were 378 (43.5%). Significant relationships were as follows: "Role Performance of Fostering Novice PHN" related to "Self-development as a PHN" (β = 0.72, p < .001); "Role Performance of Fostering Novice PHN" related to "Sharing to Foster Novice PHN" (β = 0.52, p < .001) and "Sharing to Foster Novice PHN" related to "Improving Career Development Environment" (β = 0.69, p < .001). "Role Performance of Fostering Novice PHN" and "Self-development as a PHN" related to "Professional Development for Public Health Nurse" (β = 0.31, p < .001; β = 0.29, p < .001). Moreover, "Improving Career Development Environment" related to "Awareness of Responsibility for Organization" (β = 0.33, p < .001).

Competency model for public health nurses working on tobacco control in local governments in Japan: A qualitative study

AIM

In Japan, public health nurses play a major role in tobacco control at the local government level. However, the competencies required are not clear. This study aimed to identify competencies of public health nurses working on local tobacco control in Japan.

METHODS

Twelve expert public health nurses from nine local governments in Japan participated in semi-structured interviews using the Behavioral Event Interview. Data analysis used the Iceberg Model and qualitative descriptive methods.

RESULTS

The competencies of the public health nurses were driven by three "motives": strong motivation to pioneer and change tobacco control; unwavering determination to remove barriers to tobacco control; and strong drive to achieve tobacco control. Public health nurses also showed three "attitudes": a partnership-oriented stance to delivering tobacco control; enthusiasm for evidence-based goals; and commitment to developing expertise and roles. These underpinned eight "skills": advocating to raise awareness of the need for tobacco control; positioning tobacco control as a policy issue based on regional and social situations; creating an organizational system for tobacco control; pioneering opportunities for intervention and delivering effective and locally appropriate activities; evaluating and improving the quality of tobacco control measures; developing and establishing community-based measures for tobacco-free communities; expanding activities by strategically collaborating with stakeholders; and coordinating and negotiating to avoid conflicts.

CONCLUSIONS

Public health nurses who promote tobacco control share characteristics, despite barriers such as resistance inside and outside the organization. In the future, these could be used as indicators of the competency of public health nurses working on local tobacco control.

Governing through care: A qualitative assessment of team play between police and nurses for people with mental illness

The nexus between law enforcement and public health represents a new and emerging policy field. Yet, most scholarly work has been devoted to police attitudes and interventions involving people affected by mental illness. This paper draws attention to a law enforcement - public health partnership in Amsterdam, the capital city of the Netherlands. We present a qualitative study based on interviews and some observations. Three major themes emerged from our fieldwork that involved policy makers, community police officers, and district nurses: how these officers and nurses perceive the problem of disorderly and confused people, how they work together in practice, and how they relate to a wider network of many other players. We argue that community police officers and district nurses have developed a kind of informal 'team play' consisting of three steps: receiving and analysing a signal, undertaking action, and providing aftercare. These steps offer a preventative approach aimed at avoiding and forestalling crisis situations. Difficulties arise in terms of tracing so-called 'care avoiders' (people who do not present a 'readiness for treatment'), hampered information exchange, and the governance of partners beyond our respondents' own organisations. In particular, we argue that today's society is not only governed through crime, but also through care. There is no such thing as a robust 'punitive complex' in which policing and criminal justice logics prevail. Rather, we witness a multi-agency network of police, public health, mental health, youth care housing associations and other nodal actors, each with their own bureaucratic logics and working methods tending to clash with, or even undermine, informal team play on the streets.

The HPV vaccine: knowledge and attitudes among public health nurses and general practitioners in Northern Norway after introduction of the vaccine in the school-based vaccination programme

OBJECTIVE

To investigate knowledge of and attitudes to human papillomavirus (HPV) infection, HPV vaccination, cervical cancer, related sources of information and factors associated with willingness to vaccinate one's own daughter among primary health care (PHC) personnel.

DESIGN

Cross-sectional study.

SETTING

PHC.

SUBJECTS

All public health nurses (PHNs) and general practitioners (GPs) in Northern Norway were invited to answer a structured electronic questionnaire; 31% participated (N = 220).

MAIN OUTCOME MEASURES

Self-reported and actual knowledge, information sources, attitudes and willingness to vaccinate their (tentative) daughter.

RESULTS

47% of respondents knew that HPV infection is a necessary cause of cervical cancer. PHNs had higher self-reported and actual knowledge about HPV vaccination and cervical cancer than GPs. PHNs used the Norwegian Institute of Public Health's numerous information sources on HPV, while GPs had a low user rate. 88% of PHNs and 50% of GPs acquired information from the pharmaceutical industry. 93% PHNs and 68% of GPs would vaccinate their 12-year-old daughter. In a multivariate logistic regression analysis, willingness to vaccinate one's daughter was positively associated with younger age, being PHN (OR = 5.26, 95%CI 1.74-15.94), little concern about vaccine side effects (OR = 3.61, 95%CI 1.10-11.81) and disagreement among experts (OR = 7.31, 95%CI 2.73-19.60).

CONCLUSIONS

Increased knowledge about HPV infection and vaccination is needed, particularly among GPs. Those least concerned about side effects and disagreements among experts were most likely to vaccinate their daughter. These findings are of interest for public health authorities responsible for the Norwegian vaccination and cervix cancer screening programmes, and providers of training of PHC personnel. Key points One year after introduction of HPV vaccination among 12-year-old schoolgirls in Norway, a cross-sectional study in Northern Norway among general practitioners (GPs) and public health nurses (PHNs) showed that • barely half of PHC professionals knew the causal relationship between HPV infection and cervical cancer • PHNs and GPs had higher self-reported than actual knowledge about HPV vaccination and cervical cancer nearly all PHNs and two thirds of GPs wanted to vaccinate their 12-year-old daughter. Those most concerned about side effects and disagreement among experts were less likely to vaccinate.

[Work environments for healthy and motivated public health nurses]

Objectives By defining health as mental health and productivity and performance as work motivation, the study aimed to identify work environments that promote the health and motivation of public health nurses, using the concept of a healthy work organizations, which encompasses the coexistence of excellent health for each worker and the productivity and performance of the organization.Methods Self-administered questionnaires were sent to 363 public health nurses in 41 municipal public health departments in Chiba prefecture. The questions were comprised of the 12-item General Health Questionnaire (GHQ-12) for mental health and the Morale Measurement Scale (5 items) for work motivation. Demographic data, workplace attributes, workload, and workplace environment were set as independent variables. The Comfortable Workplace Survey (35 items in 7 areas) was used to assess workers' general work environments. The "Work Environment for Public Health Nurses" scale (25 items) was developed to assess the specific situations of public health nurses. While aggregation was carried out area by area for the general work environment, factor analysis and factor-by-factor aggregation were used for public health nurse-specific work environments. Mental health and work motivation results were divided in two based on the total scores, which were then evaluated by t-tests and χ(2) tests. Items that showed a significant correlation were analyzed using logistic regression.Results The valid responses of 215 participants were analyzed (response rate: 59.2%). For the general work environment, high scores (the higher the score, the better the situation) were obtained for "contributions to society" and "human relationships" and low scores were obtained for "career building and human resource development." For public health nurse-specific work environments, high scores were obtained for "peer support," while low scores were obtained for "easy access to advice and training" and "organizational public health initiative." Mental health was found to be related to "contributions to society" (OR=2.86), "workload" (OR=3.00), and "organizational public health initiative" (OR=2.08). Work motivation was found to be related to "contributions to society" (OR=6.73) and "recognition of public health nurse's judgment and opinion" (OR=1.59).Conclusion Both mental health and work motivation were related to working environments where public health nurses can feel that their work is meaningful to society. It is therefore necessary to improve work environments so that objectives are clearly defined to raise aspirations and nurses' activities and achievements are recognized and shared.

[Collaboration between public health nurses and the private sector]

OBJECTIVES

We clarified collaborations between public health nurses (PHNs) and the private sector, such as nonprofit organizations.

METHODS

Semi-structured interviews were conducted with 11 private sector organizations and 13 PHNs who collaborate with them between December 2012 to October 2013. Interview guides were: overall suicide preventive measurements, details of collaboration between private sector organizations and PHNs, and suicide prevention outcomes/issues. Data from private sector organizations and PHNs were separately analyzed and categories created using qualitative and inductive design. Private sector organizations' and PHNs' categories were compared and separated into core categories by similarities.

RESULTS

Six categories were created: 1. establishing a base of mutual understanding; 2. raising public awareness of each aim/characteristic; 3. competently helping high suicidal risk persons detected during each activity; 4. guarding lives and rehabilitating livelihoods after intervention; 5. restoring suicide attempters/bereaved met in each activity; and 6. continuing/expanding activities with reciprocal cohesion/evaluation.

CONCLUSION

PHNs are required to have the following suicide prevention tasks when collaborating with private sector organizations: understanding the private sector civilization, sharing PHN experiences, improving social determinants of health, meeting basic needs, supporting foundation/difficulties each other (Dear editor. Thank you for kind comments. I was going to explain that PHNs and NPOs support each other their foundation of activity and difficulties in their activities. The foundations include knowledge, information, budgets, manpower etc. The difficulties mean like suffering faced with suicide during activities.), and enhancing local governments' flexibilities/ promptness.

[A Long Way Home: The Current State of Care Provided by Family Caregivers and Public Health Nurses to Persons With Mental Illness in the Community]

According to Taiwan's Health and Welfare Ministry statistics, Taiwan had a total of 122,538 people who were officially registered as mentally disabled at the end of December 2013. Worldwide, schizophrenia ranks as the sixth most burdensome disease in terms of total expenditures. The present paper uses the two actual care stories of the families of mental illness patients and compares and contrasts these with the community mental illness care models used in other countries. The hospital-based psychiatric and community-based mental illness care that is practiced in Taiwan presents dilemmas and has long focused on "disease-orientated care" rather than holistic care. The gap between institutional and community mental rehabilitation services in Taiwan are examined. We recommend that policy makers create an open space for mental illness family caregivers and public health nurses to engage in dialogue in order to effectively integrate the care resources available to community mental illness patients and to break down the care barriers that currently separate community mental illness patients, family caregivers, and public health nurses.

Human papillomavirus vaccine uptake in boys and girls in a school-based vaccine delivery program in Prince Edward Island, Canada

BACKGROUND

In 2013, Prince Edward Island was the first province to introduce HPV vaccine universally to grade six boys in a school-based program. Because uptake rates in boys are unknown in this type of vaccination program, uptake of HPV vaccination in boys was measured and compared with uptake rates in girls and then analyzed with factors such as county, urban-rural location of the school, and school board to identify where the vaccine program could be improved.

METHODS

HPV vaccination records from the provincial childhood immunization registry in PEI were merged with Department of Education data containing all grade six girls and boys in PEI. Vaccine uptakes between years and between sexes were compared using two sample tests of proportions. Logistic regression modeling which accounted for the hierarchical nature of the data was used to analyze associations between factors and uptake rates.

RESULTS

Although uptake was high in boys and girls, a significantly greater proportion of girls (85%) received all three doses of the HPV vaccine compared to boys (79%; p=0.004). The odds of grade six girls being fully vaccinated for HPV were 1.5 times greater than of grade six boys, and the odds of students in the English Language School Board receiving all three doses were more than twice as great as the odds of French Language School Board students.

CONCLUSIONS

HPV vaccination for boys in PEI has had a successful launch, almost reaching the Canadian Immunization Committee recommendations of >80% for the early years of a program. PEI has a highly organized Public Health Nursing program that is involved in all childhood and school-based vaccinations in PEI and in this context very high coverage rates were obtained. Areas to target for improving uptake include the boys and the students in the French Language School Board.

Public health nurse educators' conceptualisation of public health as a strategy to reduce health inequalities: a qualitative study

BACKGROUND

Nurses have long been identified as key contributors to strategies to reduce health inequalities. However, health inequalities are increasing in the UK despite policy measures put in place to reduce them. This raises questions about: convergence between policy makers' and nurses' understanding of how inequalities in health are created and sustained and educational preparation for the role as contributors in reducing health inequalities.

AIM

The aim of this qualitative research project is to determine public health nurse educators' understanding of public health as a strategy to reduce health inequalities.

METHOD

26 semi-structured interviews were conducted with higher education institution-based public health nurse educators.

FINDINGS

Public health nurse educators described health inequalities as the foundation on which a public health framework should be built. Two distinct views emerged of how health inequalities should be tackled: some proposed a population approach focusing on upstream preventive strategies, whilst others proposed behavioural approaches focusing on empowering vulnerable individuals to improve their own health.

CONCLUSION

Despite upstream interventions to reduce inequalities in health being proved to have more leverage than individual behavioural interventions in tackling the fundamental causes of health inequalities, some nurses have a better understanding of individual interventions than take population approaches.

The power of relationships: exploring how Public Health Nurses support mothers and families during postpartum home visits

Postpartum home visiting by Public Health Nurses (PHNs) has been used by many health departments across Canada as a way of supporting new mothers and their families. Although positive health outcomes are linked with support from PHNs, little is known about how this occurs during the home visit. The purpose of this research was to explore how home visiting programs for mothers and babies were organized, delivered, and experienced through the everyday practices of PHNs, mothers, and managers in Nova Scotia, Canada. Feminist poststructuralism was used to guide the research and semi-structured face-to-face interviews were conducted with 16 PHNs, 16 mothers, and 4 managers. Participants described how relationships were an essential part of supporting mothers and families. These findings also challenge dominant health discourses and stereotypes that are often associated with mothering and the practice of PHNs with families.

'We need to work together to create a culture of health' says PHE director

A website for public health nurses that provides comprehensive, up-to-date information on the most common issues affecting the nation's health has been launched.

[Role and function of public health nurses in Taiwan: review of current status and future perspectives]

Public health nursing is a core practice of primary health care. Public health nurses (PHNs) in Taiwan act both as individual/family-based primary care providers and as population-based community care providers. Previous studies in Western countries have shown the role preference of PHNs to be highly influenced by the structure of the healthcare system, policies and major programs, and health insurance reimbursement mechanisms. Thus, the impact of the health transition and related changes in the abovementioned systems should be taken into consideration when adjusting the roles and functions of PHNs. The rising prevalence of chronic diseases and the multiple burdens caused by diseases is making healthcare delivery increasingly complicated. With PHNs no longer able to provide "catch-all" services due to manpower shortages, several potential specialty areas have opened up to participation and development by community nursing. These include psychiatric care, long-term care and palliative care, school/workplace health promotion, and disease management in hospitals. It will be essential that community nurses bridge the gap in service left by PHNs so that PHNs may refocus their job role on the health needs of the community as a whole. PHNs should continue to build partnerships with primary care settings and perform the key functions of demonstration, support, collaboration, service, and surveillance in the community.

[Development of a scale measuring the competences of public health nurses in public health policy in Japanese administrative agencies]

OBJECTIVES

There is an urgent need to build healthy communities and increase the public health nursing capacity to solve the complex and diverse health problems in modern society. The purpose of this study was to develop a scale called the Competences of Public health nurses in Public health policy (hereinafter referred to as the CPP scale), and to test the reliability and validity of the scale.

METHODS

A literature review, individual qualitative interviews with five expert public health nurses, and surveys of all public health nurses in the local governments in one ordinance-designated city in Japan (n=460) were conducted.

RESULTS

A factor analysis of the results showed that the CPP scale contained two factors and 16 items: the first factor was "Community Partnership," and the second factor was "Community Nursing Diagnosis Cycle." Confirmatory factor analysis for the CPP scale demonstrated high fit indices (GFI=.889, AGFI=.847, CFI=.956, RMSEA=.068). The Cronbach's α coefficient of the scale was 0.93, and the scale scores were significantly correlated with the standardized scale, the Competency Measurement of Creativity (r=0.52, P<0.01).

CONCLUSION

It was concluded that the CPP scale had sufficient reliability and validity to assess the competency of public health nurses in forging public health policy.

A randomized controlled trial of a public health nurse-delivered asthma program to elementary schools

BACKGROUND

Childhood asthma is a serious and common chronic disease that requires the attention of nurses and other school personnel. Schools are often the first setting that children take the lead in managing their asthma. Often, children are ill prepared for this role. Our study evaluated a school-based, multifaceted asthma program that targeted students with asthma and the broader school community.

METHODS

A randomized trial involving 130 schools with grades 1-5 and 1316 children with asthma and their families was conducted. Outcomes of interest for the child, at 1 year, were urgent care use and school absenteeism for asthma, inhaler technique, and quality of life, and for the school, at 14 months, were indicators of a supportive school environment.

RESULTS

Improvements were observed at the child and school level for the intervention group. Fewer children in the intervention group had a school absence (50% vs 60%; p < .01), required urgent care for asthma (41% vs 51%; p < .0001), or reported a day of interrupted activity (51% vs 63%; p < .01), and had improved quality of life (5.8 ± 1.2 vs 5.4 ± 1.4; p < .0001). Schools in the intervention group were more likely to have practices supporting an asthma-friendly environment.

CONCLUSIONS

Implementation of a multifaceted school-based asthma program can lead to asthma-friendly schools that support children with asthma to be successful managers of their asthma and experience improved quality of life and decreased disease associated burden.

[Public health nurse support at initial community DOTS meetings with non-hospitalized tuberculosis patients--comparison of patients who did and did not complete treatment]

PURPOSE

This study focused on the initial meeting between public health nurses and TB patients to investigate the detection of patients' needs and the support provided by public health nurses during the meeting, with the aim of successfully implementing a directly observed treatment short course (DOTS) strategy for the community.

METHODS

A self-administered questionnaire was sent to nurses responsible for community DOTS strategy for TB in Aichi, Gifu, Mie, and Shizuoka prefectures in the Tokai region in order to collect the following information concerning the initial meeting between public health nurses and TB patients: nurses' characteristics, patient characteristics, information collected by the nurses, concerns expressed by patients, and specific support provided by the nurses. Data collected were compared between patients who completed TB treatment (complete treatment group) and those who did not (incomplete treatment group).

RESULTS AND DISCUSSION

Valid responses were obtained from 42 public health nurses regarding 158 TB patients. The incomplete treatment group had a high proportion of patients who received no support from their families, had irregular lifestyles, or had financial problems. There were discrepancies between the information collected by public health nurses and patients' concerns. It was also revealed that public health nurses provided more specific support and a wider range of support to the incomplete treatment group, suggesting that public health nurses give specific support in the initial meeting to patients who were likely to discontinue TB treatment, thereby motivating them to complete the treatment.

CONCLUSIONS

It is essential to arrange initial public health nurse-patient meetings at an early stage to build patients awareness of the disease and the importance of treatment adherence. Continuous support is crucial until the patients complete treatment.

[Development of the role scale for municipal supervising public health nurses]

OBJECTIVES

As public health nurses are becoming increasingly decentralized in municipalities, recommendations for allocating supervising public health nurses are being made. This study aimed to develop a scale for measuring the implementation of role of municipal supervising public health nurses and to test its reliability and validity.

METHODS

Scale items were developed using results of a qualitative inductive analysis of interview data, and the items were then revised following an examination of content validity by experts, resulting in a provisional scale of 17 items. A self-administered, written questionnaire was then completed by supervising public health nurses or public health nurses holding the most senior positions in all municipalities nationwide, with the exception of three prefectures in the Tohoku region (total 1,621 locations).

RESULTS

In total, 1,036 responses were received, and 931 were used for analysis (valid response rate = 57.4%). Of these, 406 were completed by supervising public health nurses. After deleting one item as a result of item analysis and conducting principal component analysis, factor analysis was conducted using the major factor method and Promax rotation. One item with high loading on multiple factors was deleted, resulting in a scale comprising 15 items and 3 factors. The cumulative contribution ratio was 56.10%. The three factors were labeled "Promotion of health activities across the whole locality," "Coordination as a PHN role leader," and "Development of the skills of public health nurses". The reliability coefficient of the RMSP (Role Scale for Municipal Supervising Public Health Nurses) as a whole was 0.84 using the split-half method (Spearman-Brown formula) and 0.91 using Cronbach's alpha, confirming internal consistency. In terms of validity, an examination was conducted of the correlation of two RMSP scale scores (strength of awareness of role as a supervising public health nurse and confidence as a supervising public health nurse) and scores on existing scales assessing management abilities, and a significant correlation (P < 0.01) was obtained. Additionally, a comparison of the RMSP scores of decentralized local public health nurses according to rank and years of service in areas where there were no supervising public health nurses with the RMSP scores of supervising public health nurses showed that the scores of supervising public health nurses were higher.

CONCLUSION

The developed scale was found to be reliable and valid for measuring the implementation of supervising public health nurses' role.