Enhancing Public Health Nursing Competencies Through Game-Based Education

1) To describe the community health nursing workforce in Canada; 2) To compare, across political jurisdictions and community health sectors, what helps and hinders community nurses to work effectively; 3) To identify organizational attributes that support one community subsector--public health nurses--to practise the full scope of their competencies. Our study included an analysis of the Canadian Institute for Health Information nursing databases (1996-2007), a survey of over 13,000 community health nurses across Canada and 23 focus groups of public health policy-makers and front-line public health nurses. Over 53,000 registered and licensed practical nurses worked in community health in Canada in 2007, about 16% of the nursing workforce. Community nurses were older on average than the rest of their profession. Typical practice settings for community nurses included community health centres, home care and public health units/departments. To practise effectively, community nurses need professional confidence, good team relationships, supportive workplaces and community support. Most community nurses felt confident in their practice and relationships with other nurses and professionals, though less often with physicians. Their feelings about salary and job security were mixed, and most community nurses would like more learning opportunities, policy and practice information and chances to debrief about work. They needed their communities to do more to address social determinants of health and provide good quality resources. Public health nursing needs a combination of factors to succeed: sound government policy, supportive organizational culture and good management practices. Organizational attributes identified as supports for optimal practice include: flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; coordinated public health planning across jurisdictions; and strong leadership that openly promotes public health, values their staff's work and invests in education and training. The interchangeable and inconsistent use of titles used by community nurses and their employers makes it difficult to discern differences within this sector such as home care, public health, etc. Our studies also revealed that community nurses: thrive in workplaces where they share the vision and goals of their organization and work collaboratively in an atmosphere that supports creative, autonomous practice; work well together, but need time, flexible funding and management support to develop relationships with the community and their clients, and to build teams with other professionals; could sustain their competencies and confidence in their professional abilities with more access to continuing education, policies, evidence and debriefing sessions.

Objectives: 1) To describe the community health nursing workforce in Canada; 2) To compare, across political jurisdictions and community health sectors, what helps and hinders community nurses to work effectively; 3) To identify organizational attributes that support one community subsector - public health nurses - to practise the full scope of their competencies. Methods: Our study included an analysis of the Canadian Institute for Health Information nursing databases (1996-2007), a survey of over 13,000 community health nurses across Canada and 23 focus groups of public health policy-makers and front-line public health nurses. Results: Over 53,000 registered and licensed practical nurses worked in community health in Canada in 2007, about 16% of the nursing workforce. Community nurses were older on average than the rest of their profession. Typical practice settings for community nurses included community health centres, home care and public health units/departments. To practise effectively, community nurses need professional confidence, good team relationships, supportive workplaces and community support. Most community nurses felt confident in their practice and relationships with other nurses and professionals, though less often with physicians. Their feelings about salary and job security were mixed, and most community nurses would like more learning opportunities, policy and practice information and chances to debrief about work. They needed their communities to do more to address social determinants of health and provide good quality resources. Public health nursing needs a combination of factors to succeed: sound government policy, supportive organizational culture and good management practices. Organizational attributes identified as supports for optimal practice include: flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; coordinated public health planning across jurisdictions; and strong leadership that openly promotes public health, values their staff's work and invests in education and training. Conclusion: The interchangeable and inconsistent use of titles used by community nurses and their employers makes it difficult to discern differences within this sector such as home care, public health, etc. Our studies also revealed that community nurses: thrive in workplaces where they share the vision and goals of their organization and work collaboratively in an atmosphere that supports creative, autonomous practice; work well together, but need time, flexible funding and management support to develop relationships with the community and their clients, and to build teams with other professionals; could sustain their competencies and confidence in their professional abilities with more access to continuing education, policies, evidence and debriefing sessions. Key words: Community health nursing; public health nursing; demographic profile; enablers for nursing practice; Canada

Simulation activities are valuable for nursing education and provide an experimental learning opportunity. However, simulation scenarios have focused on nursing education of traditional medical specialities, and limited research exists on simulation for community or public health nursing education. This study aimed to explore the methods that are being used to increase the knowledge and skills of nursing students who work for public health nursing and the evidence about the effectiveness of simulation practices in public or community health nursing. In this systematic review, a combination of keywords was selected from Medical Subject Headings based on which eight studies were found across Science Direct, Web of Science, EBSCO, Cochrane and PubMed databases between June 2018 and September 2018. A total of eight studies were included in the mixed-methods systematic review (two qualitative, two mixed-methods and four quantitative studies). The students were satisfied with public health nursing simulation practices and had significant gains in the following activities: active learning, collaboration, critical thinking, teamwork, evaluating family and individual together, and practical communication skills. The results of this review revealed that the experiences and gains of the nurses that they gain during their education process were essential, the numbers of simulation practices in the field of public health nursing were minimal, and they should be improved qualitatively.

The practices required by community and public health nurses to establish community networks mainly involve communicative competencies. Assessment through development and testing of such competencies is necessary for community and public health nurse educators and practitioners around the world to create and maintain a mutual support network. The purpose of this study was to develop and test a scale for community and public health nurse practices to establish and maintain community networks, and to then determine construct validity in a factorial structure model. The participants were 3970 community and public health nurses in Japan. A 43-item list was developed from a literature review, individual interviews, and repeated examinations. The secondary structural model consisted of four factors with 21 items. The internal consistency of the 21 items was highly reliable (Cronbach's α = 0.915). Confirmatory factor analysis by structural equation modeling showed the fit criteria to be statistically significant. Attributes of the community and public health nurses (age, years of experience, work municipalities, work positions, and educational institutions) showed significant relationships with the scale scores. The findings validated the efficacy of the Network Establishment Practices Scale to assess community and public health nurse practices to establish community networks.

1findings presented in the September/October 2009 issue of the CJPH offer an original and significant contribution in the realm of public health nursing in Canada. The analysis by Underwood et al. involves a threefold research approach (analyses of manpower data banks, questionnaire survey and discussion groups) that pinpoints several crucial issues, including the aging labour force; scarce replacement staff; inconsistency in the definition of work environments, services and occupational titles; and shortcomings in information systems. The study also highlights several factors that affect nursing practices, especially for nurses working in public health, such as government policies and programs, organizational culture and management practices. The article is based on a nationwide sampling and does not present provincial and territorial profiles. A study conducted in Quebec at more or less the same time (the Pratiques infirmieres en prevention et promotion Project [PPP Project]) among nurses working in CLSC components of the recent CSSS corroborates several observations made by Underwood et al., at least from the standpoint of professional and contextual factors that affect nursing practices in community and public health. 2 Without undertaking a detailed comparative analysis, it appears that both studies underscore the need for continuing education initiatives to enhance professional development as well as increased networking opportunities between nurses and other professionals through various forums to further expand their practice. However, the PPP Project highlights additional conditions that are not reported by Underwood et al.: shortcomings in initial training in the domains of community and public health nursing, paucity of knowledge and competency with regards to the new public health and population-based approaches, 3 and nurses’ mitigated roles in terms of programme planning

The American Public Health Association defines public health nursing as the "practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences." In 1993, celebrating the centennial anniversary of its founding, nurse leaders recognized systemic changes have required nurses to function in clinical, illness-oriented roles rather than in their more traditional community and public health roles. With nurses' public health skills atrophying, these leaders urged members of the profession to eschew specialization and return to their generalist roots founded on the principles of community-based prevention and health promotion. Soon the Public Health Functions Project, designed in part to identify skills and curriculum needs of an array of practicing public health workers, examined the public health nursing profession. Its recommendations seek to ensure that public health nurses are trained to respond to current challenges that face public health. In this essay, we describe how a fellowship program that predated this national project by almost a decade anticipated the recommendations for shaping public health nursing by enrolling midcareer nurses in a program that taught the principles and practice of community-oriented primary care. Such principles represent a merger of clinical care with population health sciences; its more recent expressions teach clinicians to work as partners with communities to identify and address health problems. In reporting on this program, we show how nurses in practice can embrace their generalist roots, meet current challenges, and play a lead role in realizing the nation's goals for the year 2010. These aims incorporate recent recommendations for preparing public health nurses for change in the health care system.

Community health and public health nursing is a relevant issue in the context of the Portuguese National Health System reforms. International organizations, such as the World Health Organization, have emphasized the importance of nurses in community and public health care, and international studies report ongoing changes in this area in many countries. Through a Systematic Literature Review, conducted in early 2019, following an Equator Network protocol, Systematic Reviews, CRD's guidance for undertaking reviews in health care, prepared by York University, we addressed the research issue: what has been published about community health and public health nurse competencies and interventions. The inclusion of articles followed PRISMA 2009 and 36 of the total number of publications were selected. The contributions refer to the expansion of nurses’ competences, events such as health fairs, nutrition, and caries assessments, performance in contexts of natural disasters, development of management skills, understanding and influencing the making of public health policies. With the ongoing public health reform taking place in Portugal, it is also a good opportunity for nursing to investigate, produce, innovate, and recreate itself.

There is evidence that public health is currently taking centre stage in the challenge to improve the population's health. This represents a change from the 1980s and 1990s where health promotion was the dominant concept among community nurses. Public health means different things to different people and while nurses have a role to play, there is a need to be more precise about their specific contribution. The creation of public health nursing posts across the UK is contribution to this confusion, as there is little emerging consensus as to what professionals in these posts should do. At present, there does not appear to be a dominant strategy or model of working. A preliminary analysis of job advertisements for public health nursing posts indicates a requirement for a 'supercharged' health visitor to work in a specific area to provide a link between the professional and lay communities. The emphasis is on community development with little on population health. Government policy on public health clearly highlights the important role of nurses in contributing to the public health agenda. The current role and function of public health nursing posts may not allow them to be classed as specialist public health nurses/nursing and to provide educational opportunities for nurses to develop the knowledge and skills which will enable them to work alongside medical and other healthcare colleagues in the pursuit of specialist public health practitioner status.

Developing public health nursing: barriers perceived by community nurses

The purpose of this study was to explore the online discussions of postlicensure nursing students taking a community health course in an RN-to-BSN program. Final discussion forums asked students to share their perceptions and understandings of the public and community health nurses' role and practice after participating in a community health clinical course. Inductive content analysis was used to assess the narratives. Analysis of the discussions yielded two categories: (1) awareness by the RNs of their individual community and the context of the public and community health nursing role, and (2) increased understanding of the patients' experience with transitions between health care settings (home-hospital-home). This research suggests a need to assess practicing RNs' professional understanding and teaching of the public and community health nurses' role if they are to facilitate effective patient transitions home and into community-based settings.

Purpose: This study aims to understand the functions and roles of public health nursing, which played a key role in public health center activities during the formative years of the organizations in Korea. It does so by analyzing the structure and content of Manual of Public Health Nursing, the first of its kind published in Korea, as well as its authors’ records—particularly the U.S. nurse advisors. Methods: Manual of public health nursing was investigated from the cover to the appendix with other related records from the U.S. National Archives and Records Administration (NARA). Results: The manual was published in response to the expansion of health centers and the increasing need for standardized practice for public health nurses. It includes theoretical and practical guidelines on maternal and child health, communicable disease control, school health, health education, etc. as well as the qualifications of public health nurses. The manual was influenced by U.S. nursing education and international public health manuals. Conclusion: The manual played a critical role in shaping early public health nursing practices in Korea by providing essential knowledge and standardizing public health services. It reflected Korea’s evolving public health system, heavily influenced by U.S. aid and technical assistance. Despite its significance, challenges such as a shortage of trained public health nurses and an underdeveloped administrative structure remained unresolved.

A scholarly concentration program to promote public health nursing for generalist Clinical Nurse Leader students.

This paper is a report of a research study to explore specialist community public health nurses’ views of their public health role. Three key objectives were set: to identify what their public health role was; to explore what the influences are on that role are; to investigate what they felt the solutions were to enhance this aspect of their role. The study design consisted of a small qualitative study that used three focus groups to collect data from practice teachers from health visiting, occupational health nursing and school nursing. The data was combined for thematic analysis of their responses to the three key topics identified. The results showed that the participants were somewhat knowledgeable about their role as public health nurses; were influenced by lack of resources, poor understanding from others of their role and tensions with managers and the wider team as to the importance of their public health role; and they offered solutions that included role clarity for effective skill mix, a shared vision for practice and debated the role of a specific public health nurse in the team. Recommendations for clear roles and responsibilities, clear protocols for assessing need and identifying priorities and performance management frameworks are offered.

Repeating history? Public and community health nursing in Australia Despite the long history in Australia of public and community health nursing, it has never been regarded as important as hospital-based nursing. Notwithstanding the establishment of nursing organisations in the very early years of the 20th century and subsequent efforts to develop the nursing workforce, public and community health nursing has been neglected in terms of policy, research into public health nursing practice and workforce development. Even in the present day, public and community health nurses are marginalised from mainstream nursing interests and there is a lack of conceptualisation about the value of nursing’s contribution to the primary health sector. This sector is experiencing a new wave of reforms driven by a combination of managerialism and systems change for improved responses to address health inequalities. Because there is not a strong institutionalised professional policy and support base for public and community health nurses, they are vulnerable in these reforms to increased domination and appropriation of their practice by stronger professional interests. There is an urgent need for professionally organised support from mainstream nursing to ensure that public and community health nurses are positioned as a unified force in efforts to advance the health of the community.

Various authors have noted that the terminology relating to 'community nursing', 'community health nursing' and 'public health nursing' have continued to change over the years, and that this has lead to a lack of conceptual clarity (Flynn 1988, Highrighter 1984, Sills & Goeppinger 1985). With the addition of the concept of primary health care (WHO-UNICEF 1978) there has been added confusion about the meaning of terminology used. This confusion contributes to uncertainty about nurses' practice role in primary health care. This paper explores the differing approaches to interpreting the meaning of primary health care and addresses itself to clarifying the community health nursing practice role in primary health care.