Public Health Nursing Vol. 32 No. 6, pp. 711–720 0737-1209/© 2015 Wiley Periodicals, Inc. doi: 10.1111/phn.12191

SPECIAL FEATURES: CLINICAL CONCEPTS

Public Health Nursing Activities: Visible or Invisible? Marjorie A. Schaffer,1 Linda Olson Keller,2 and Dawn Reckinger3 1

Nursing, Bethel University, St. Paul, Minnesota; 2University of Minnesota, Minneapolis, Minnesota; and 3Minnesota Department of Health, St. Paul, Minnesota

Correspondence to: Marjorie A. Schaffer, Nursing, Bethel University, 3900 Bethel Drive, St. Paul, MN 55112. E-mail: [email protected]

ABSTRACT Objective: To promote visibility of public health nurses (PHNs), this study identified public health nursing activities and explored PHN perceptions of the impact of their activities on the health of the communities they serve. Design and Sample: Two surveys with questions focusing on PHN activities were made available electronically. Following the initial survey, the second survey had more detailed questions about PHN activities, including time spent and frequency of activities as well as open-ended questions. Sixty staff level PHNs, representing 29 states, completed the first survey; 49 completed the second survey. Measures: Demographic variables and PHN activities were analyzed by population, setting, program, intervention, essential services, and prevention level using descriptive statistics. Themes or categories were determined through a content analysis of responses to three open-ended questions. Results: PHNs reported a wide variety of activities that included: (1) individual/family, community, and systems intervention levels, (2) primary, secondary, and tertiary prevention, and (3) all 10 Public Health Essential Services. PHNs perceived they perform work that is essential for community health. Conclusion: PHNs do work that is both visible and invisible. PHNs need to be proactive in promoting all their work to increase the visibility of their contributions to population health. Key words: interventions, nursing workforce, public health nursing practice.

Public health nurses (PHNs) comprise the largest segment of the public health workforce (Bekemeier & Jones, 2010; Gebbie & Merrill, 2001; Hill, Butterfield, & Kuntz, 2010). The 2013 National Profile of Local Health Departments identified that for all LHDs (local health departments), the median number of FTEs (full time equivalents) was 17, including four nurses (National Association of County and City Health Officials [NACCHO], 2014). In 2013, nurses represented 19% of FTEs in local health departments. Overall, 96% of health departments reported employing nurses. However, between 2008 and 2013, the total number of registered nurses employed by LHDs dropped from 32,900 to 27,700, a decrease of over 5,000 nurses (NACCHO, 2014). The declining number of PHNs raises concern about the availability of an adequate

number of PHNs to contribute their knowledge and skills to improving population health.

Background Public health nursing knowledge and skills. Public health nurses are interdisciplinary, synthesizing the science and art of both nursing and public health. Public health nurses bring unique education, knowledge, experience, and a skill set to the interdisciplinary practice of public health (NACCHO, 2014; Schaffer et al., 2011). Their clinical nursing experiences prepare them to work with communities, families, and individuals across the entire life span. Two frameworks that identify the knowledge, skills, and values of PHNs are the Public Health Intervention Wheel and the Cornerstones of Public

711

712

Public Health Nursing

Volume 32

Number 6

Health Nursing. The Public Health Intervention Wheel (Public Health Nursing Section, 2001), which provides a framework for explaining what public health nurses do, delineates 17 interventions at the individual/family, community, and systems levels of practice. The development of the framework was guided by evidence and confirmed by practicing PHNs (Keller, Strohschein, Lia-Hoagberg, & Schaffer, 2004). The Cornerstones of Public Health Nursing identify the values and beliefs that are foundational for public health nursing practice (Keller, Strohschein, & Schaffer, 2011). The Cornerstones are a synthesis of public health and nursing and encompass emphases on the health of populations, community priorities and needs, caring relationships, social justice, holistic health, epidemiological evidence, collaboration, and authority for independent practice based on the Nurse Practice Act. The Cornerstones articulate a vision for public health nursing that explains “the why” of public health nursing, thereby increasing visibility for PHNs. The emphasis on interventions for populations as well as health department budget cuts have contributed to changes in public health nursing practice, requiring new knowledge and skills. Current practice requires more complex skills than in the past and has shifted toward an emphasis on populations and collaboration (Smith & Bazini-Barakat, 2003; Zahner & Gredig, 2005). However, several authors have suggested there may be a gap in the education and training of public health nurses for competency at the community and systems levels (Bekemeier & Jones, 2010; Grumbach, Miller, Mertz, & Finocchio, 2004). Although an analysis of PHN job descriptions showed that the job descriptions included population-focused professional standards (Issel, Ashley, Kirk, & Bekemeier, 2012), a review of position descriptions for PHN directors and supervisors revealed that few included the American Nurses Association PHN standard of “population diagnosis and priorities” (Polivka, Chaudry, & Jones, 2014). Visibility of public health nurses. Nurses from Norway, Canada, Ireland, and the United States have addressed the issue of visibility in public health nursing. Researchers in Norway suggested that independent work, generalized guidelines for public health nursing in laws, the challenge of

November/December 2015

defining public health nursing tasks, and changes in Norwegian law that led to reduced leadership by PHNs in municipal health services have contributed to a lack of visibility for PHNs in Norway (Clancy, 2007; Clancy & Svensson, 2009). Meagher-Stewart et al. (2010) from Canada commented that the complex nature of public health nursing is a challenge for defining the tasks of public health nursing. To promote visibility in public health nursing, they suggested that leadership should develop a vision for public health linked to public health goals, role clarity, evidence, and community needs. Clarke (2004) featured the stories of PHNs in Ireland as a strategy to make visible the “unquantifiable” work that PHNS do in homes and communities. The “unstructured, uncontrolled, and sometimes chaotic working environment” (p. 193) as a frequent context for public health nursing activities contributes to a “hidden” public health nursing practice in comparison to the disease-specific model of health service delivery, which is quite visible. PHN stories illustrated the holistic and relationship-based approach to working with clients in family and community settings. Also in Ireland, Nic Philibin et al. (2010) found that nurses practicing in community settings identified a hidden role in making decisions, assessing needs, and counseling clients. This practical knowledge of the community is critical for developing systems strategies for contributing to improved population health outcomes; however, the relationships and resulting outcomes may not be clearly visible or measureable. Based on the stories of PHNs from the United States, SmithBattle, Diekemper, and Leander (2003a,b) suggested relational skills “honed over time’ (2003a, p. 9) contribute to the ability to understand the community “through the eyes of clients” (2003b, p. 95), which then leads to upstream thinking and clinical reasoning about effective strategies for improving population health. However, both relationship-based work and how PHNs use their expertise in population-based activities often goes on “behind the scenes” and is unseen. Both the public and policymakers are apt to pay more attention to what has gone wrong rather than what has been prevented.

Purpose This study identified PHN activities and explored PHN perceptions about: (1) activities they per-

Schaffer et al.: Public Health Nursing Activities formed that have the greatest impact on the health of their community, (2) what would happen if there were no public health nursing services, and (3) activities considered essential that PHNs were unable to provide. Knowledge about PHN contributions to the health of populations is important for policy decisions about resources and funding to support the public health infrastructure.

Methods Design and sample Data for this study were obtained from Keller and Litt’s (2008) task analysis of activities of PHNs working in governmental health departments in the United States. Nominations for study participants were requested from all states and territories of the United States; 31 states and one territory submitted nominations. Requirements for nomination included having: (1) a baccalaureate degree in nursing, (2) three or more years of experience as a PHN, (3) a staff PHN position, and (4) responsibility for the day-to-day public health nursing activities in the setting in which he/she was employed. An exception to the eligibility requirements was made to include two participants from a state that primarily employs associate degree prepared PHNs. This study was reviewed and approved by the University of Minnesota Institutional Review Board. Participants were selected to assure range in geographic location, size of health department, years of experience, and job responsibilities. A participant from every state that submitted a nomination was automatically selected to assure the broadest possible representation. From 103 nominations, 72 were selected and 60 agreed to participate, representing 29 states. Measures Participants completed two online surveys. Keller and Litt (2008) developed the surveys based on an analysis of 50 PHN job descriptions, literature on PHN activities, the Public Health Nursing Scope and Standards of Practice (American Nurses Association, 2007), and the Public Health Intervention Wheel. The initial survey (114 items) identified activities performed by the PHNs; the second survey (53 items) probed for clarification and requested additional information on time and frequency of

713

activities. Based on a request from participants to provide an opportunity to add comments, three open-ended questions were added to the second survey to explore: (1) PHN activities that had the greatest impact on the health of their community, (2) the impact on the community if no public health nursing services were provided, and (3) essential or critical services that they were unable to provide. Participants took one to two hours to complete each survey.

Analytic strategy Descriptive statistics were used to report demographic results and public health nursing practice activities by population, setting, program, intervention, essential services, and prevention level. A content analysis process, consistent with a descriptive qualitative approach (Polit & Beck, 2012), was used to categorize brief responses to the three openended questions. Response rates for both surveys were high: 100% (60/60) for the first survey and 96.6% (58/60) for the second survey.

Results Participant demographics Of 60 participants from 29 states (see Figure 1 for geographic distribution), all completed the first survey. However, 49 of 60 completed the second survey; the reduced response rate may be due to survey length. Of the 60 respondents, 58 had a baccalaureate nursing degree; 11 also had a master’s degree in nursing. Two participants had an associate degree, which represented the predominant educational background of PHNs in their home state. PHNs in the sample represented the full scope of public health nursing specialty positions, in addition to generalists. Of the total sample (n = 60), participants were mostly female (n = 59), White (n = 55), and between 41 and 60 years of age (n = 49). They represented the following categories of governmental jurisdictions: county/parish health departments (n = 30), state health departments (n = 12), city/town health departments (n = 10), and district health departments (n = 4). Public health nursing activities Seventy percent of participants said their activities addressed the entire population; they also reported

714

Public Health Nursing

Volume 32

Number 6

November/December 2015

Figure 1. Geographic Representation of Survey Participants (n = 60)

they worked with specific age groups across the life span. PHN activities represented the full scope of programs and services with individuals, families, community, and systems partners (see Table 1).

TABLE 1. Summary of Public Health Nursing Activities (n = 60) Emergency preparedness Health teaching to individuals and families Receive and make referrals Immunization clinics Health promotion/prevention programs in the community Case management Facilitate vulnerable individuals’ access to services Work with groups related to public health issues Home visits Health teaching to groups Vulnerable children and/or adults Investigate disease and other health threats Health screening Educational classes, meetings, workshops for providers Advocate for increased health care availability and access Community organizing activities Lead groups related to public health issues

100% 100% 100% 93% 88% 88% 87% 87% 83% 82% 81% 78% 78% 73% 70% 60% 47%

Although the data represent 29 states, there are many similarities in reported activities. For example, 100% of PHNs reported activities in: (1) emergency preparedness, (2) health teaching to individuals and families, and (3) receiving and making referrals. They reported high percentages (above 85%) for several other PHN activities, including immunization clinics, health promotion programs, case management, facilitating health care access, and working with groups. PHNs reported that they both participated in and were leaders for community groups. They served on internal agency committees (81%), community coalitions (67%), and advisory committees (48%). PHNs chaired or provided leadership in internal agency committees (53%), community coalitions (46%), and advisory committees (32%).

Public health nursing activities by setting Public health nursing activities have typically been described by practice setting (see Table 2). Home visits are defined as visits to clients at a residence, house, shelter, half-way house, or group home. The most frequent types of home visits involved health promotion, case management, directly observed therapy (DOT), contact investigation, families with newborns, abuse and neglect, parenting, prenatal, child growth and development, postpartum, special needs child, and elevated blood lead level. PHN practice in weekly clinics included the following

Schaffer et al.: Public Health Nursing Activities TABLE 2. Public Health Nursing Activities by Setting Public Health Offices Homes Clinics Schools Shelters Senior Centers Workplaces Child-care Facilities Correctional Facilities

83.3% 65.0% 65.0% 48.3% 41.7% 31.7% 31.7% 30.0% 13.3%

programs or clients: prenatal; immunization; family planning; sexually transmitted disease; women, infant, and children; senior health; children with special health needs; DOT; and well-baby/child.

Public health nursing activities by program The five most common program areas reported were: (1) emergency preparedness, (2) prevention and control of vaccine preventable disease, (3) tuberculosis prevention and control, (4) sexually transmitted disease, and (5) maternal and child health. One-hundred percent participated in emergency preparedness activities. PHNs had responded to natural disasters including tornados, floods, hurricanes, fires, and avalanches, as well as disease outbreaks such as Hepatitis A, measles, and food borne illness over the past year. PHNs staffed immunization clinics (93.3%) and planned and conducted immunization clinics (63.3%). PHNs reported working with clients with latent or active TB (75%); 23 percent worked with TB clients on a daily basis. Sixty percent of PHNs worked with sexually transmitted diseases (STDs); 58.3% worked with HIV/AIDS. In addition to surveillance and disease investigation, the most common activities related to STDs were: counseling, screening, treatment, testing, and contact follow-up. PHNs provided maternal-child health home visits for parenting, child growth and development, families with newborns, and prenatal and postpartum women. Home visit activities included anticipatory guidance on infant and child growth and development, infant/child’s environment, home safety, infant/child car seat safety, breastfeeding, family planning, development of healthy relationships and secure attachments between caregiver and child, accessing emergency and health care resources, social supports, preventative health, immunizations, healthy eating/nutrition, and hand washing.

715

Public health nursing activities by intervention Of the 17 interventions, the most frequent interventions utilized by PHNs were advocacy, case management, screening, referral and follow-up, surveillance, and disease and other health threat investigation. Advocacy. Advocacy pleads someone’s cause or acts on someone’s behalf, with a focus on developing the client’s capacity to plead their own cause or act on their own (Keller et al., 2004). PHNs facilitated access to services and basic life needs for vulnerable individuals and advocated for improved health care availability and access. They scheduled physician appointments or transportation; assured the adequacy of basic life needs such as food/nutrition, housing, clothing, and transportation; arranged for interpreters; conducted assessments of vulnerable children and adults; followed up on referrals for potential neglect or abuse for vulnerable children and adults; and provided information to court officials in cases of child and adult protection. Case management. Case management, the arrangement and coordination of services that effectively and efficiently meet the comprehensive needs of clients (Keller et al., 2004), was provided by 88.3% of PHNs. The 10 most frequently served populations were: individuals with latent or active TB, pregnant women, families with newborns or young children, breastfeeding women, with elevated blood lead levels, children with disabilities, individuals with chronic disease, individuals experiencing mental illness, frail older adults, and persons with HIV/AIDS. Screening. Screening identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations (Keller et al., 2004). Over 78% of PHNs conducted 32 different types of screenings for a wide range of populations and conditions across the life span. The most frequent types of screening included: immunization status, tuberculosis, hypertension, infant/child growth and development, pediculosis, nutrition, anemia, perinatal health, postpartum depression, abuse and neglect, body mass index, elevated blood lead levels, and vision and hearing.

716

Public Health Nursing

Volume 32

Number 6

November/December 2015

Referral and follow-up. Referral and followup assists individuals, families, groups, organizations, and communities to utilize necessary resources to prevent or resolve problems or concerns (Keller et al., 2004). PHNs are both the “senders” of referrals (the initiators of referrals on behalf of clients) and “receivers” (the recipients of referrals from others). All PHNs (100%) reported receiving and making referrals. On average in a typical week, a PHN made six referrals and received four. Surveillance. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions (Keller et al., 2004). PHNs conducted ongoing surveillance for tuberculosis, vaccine preventable diseases, sexually transmitted diseases, pediculosis, food borne diseases, and elevated blood lead levels in their communities. Over 72% of the PHNs reported notifiable diseases to local or state health departments. Disease and other health threats investigation. When surveillance detects a potential problem, disease, and other health event investigation systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures (Keller et al., 2004). PHNs investigated disease and other health threats (88.3%), most frequently in the general community setting. Other settings in which PHNs commonly conducted investigations included: schools, child-care facilities, clinics, workplaces, long-term care facilities, and correctional facilities. Tuberculosis was the most commonly investigated condition, followed by vaccine preventable disease, sexually transmitted disease, food borne disease, pediculosis, elevated blood lead levels, and vectorborne disease.

Essential public health services and prevention levels The Essential Public Health Services describe the public health activities that should be undertaken to achieve health in every community (Public Health Functions Steering Committee, Members, 1995). Respondents estimated the percentage of time spent on each essential service (see Figure 2).

Figure 2. Percentage of Time Essential Services (n = 57)

Dedicated

to

The most predominant essential service was “inform, educate, and empower.” PHNs reported over half (52%) of public health nursing activities as primary prevention, 28% were secondary prevention, and 20% were tertiary prevention.

Responses to open-ended questions Responses to open-ended questions are summarized in Table 3. Most responses were brief and addressed specific activities, resulting in categorization of responses specific to each question. In addition, selected PHN quotes add insight about their perceptions of the value and effectiveness of their work. Activities that have the greatest impact on community health. Four major categories of activities were identified: (1) childhood immunizations, (2) communicable disease (including tuberculosis and sexually transmitted infections) surveillance, education, and investigation, (3) maternal and child health-focused activities (early intervention and school readiness activities, prenatal and parenting education, case management of high risk families, and growth and development follow-up), and (4) linking people to resources. One PHN addressed the importance of the advocacy role in helping young families connect with needed resources to help overcome barriers to family well-being: I support and advocate for young women and families in relation to pregnancy and parenting. I

Schaffer et al.: Public Health Nursing Activities

717

TABLE 3. Analysis of Responses to Open-Ended Questions 1. Describe the activities that you do as a PHN that have the greatest impact on the health of your community 2. What would be the impact on the health of the community if there were no public health nursing services? 3. What public health nursing activities are you not able to perform that you consider essential to the health of your community? PHN Activities with Greatest Impact if No PHN Services (n = 49) Critical Services Not Able to Impact (n = 49) Provide (n = 47) Programs Disease and health problems Childhood immunizations (15) Family health (6) Communicable disease (32) Communicable diseases (15) Substance abuse (4) Lack of immunization (12) Family health (13) Older adults (4) Lack of family planning leading to Link to resources (7) Mental health (2) more unwanted Others—WIC and nutrition, Family planning (1) and teen pregnancy (10) screening, health Health promotion (2) Poor child health outcomes (10) teaching, consultation, school Prevention (8) Lack of prevention leads to worse health (11) health, home Treatment (2) Less care for vulnerable populations (9) visits, health promotion, Interventions Negative changes in public health emergency preparedness Education (7) infrastructure (9) Home visiting (4) Negative effects on local health Outreach (3) department programs (8) Working with communities (2)

assist them to access services that they would not otherwise know about or have the confidence to seek out. I help families achieve independence so that they can become productive citizens and better parents. I educate parents on best practices in raising and taking care of their children’s needs. I monitor child neglect and abusive environments and assist families in ways to overcome neglect and abuse.

PHNs also identified the importance of health promotion and health teaching activities in reaching populations. A participant commented, The least visible of my activities actually reaches the greatest number of people with health teaching via several community newsletters. These are current relevant topics each month that are read by nearly 3,000 residents.

Impact of no public health nursing services on community health. PHN perceptions of the negative impact included: (1) occurrence of disease and health problems, (2) worse health due to lack of prevention, (3) less care for vulnerable populations, (4) negative changes in public health infrastructure, and (5) negative effects on local health department programs. PHNs expressed a high level of concern about increasing communicable disease. PHNs expected that immunization rates would decline, particularly for lower income populations. They also projected an increase in

unplanned and teen pregnancies as well as an increase in child abuse and neglect. A PHN stated, “I believe more children would be placed in increasingly violent or dangerous environments.” Without public health nursing services PHNs predicted there would be less early diagnosis of cancer, less prevention that would lead to more disease with resulting increased hospitalizations, and a decrease in awareness of public health issues. Ultimately, this would result in a decline in health for the whole community. PHNs wrote about the potential negative effects of lack of services for vulnerable populations; they predicted there would be less preventive care, a greater use of emergency departments, and a lack connecting mentally ill and disabled clients to needed resources. One participant said, “The most vulnerable among us would suffer immeasurably.” Regarding public health infrastructure, PHNs discussed the lack of a safety net, the loss of a 24/7 information source on emergency preparedness, the lack of a community assessment process, fragmentation of services with little collaboration, and the resurfacing of health hazards. PHNs expressed concern about potential negative impact on health department programs. They remarked that their health department is a reliable source of information for the community. A participant characterized PHNs as being trustworthy,

718

Public Health Nursing

Volume 32

Number 6

approachable, and holistic, which contributes to the confidence the public has in recommendations made by PHNs. A respondent commented, The impact would be devastating. While all aspects of public health are important, it is the nurse who pulls all the little pieces together. It is the nurse who looks at the big picture to ensure services are being received.

Critical PHN activities that were not provided. Categories of critical services that PHNs were unable to provide included: (1) programs, (2) prevention activities, and (3) PHN interventions. Several PHNs wanted to expand services to older adults. They identified wanting to expand services for family planning, child-care centers, and substance abuse and mental health. Commenting on family health services, a PHN stated, Our caseload is very heavy and I have to prioritize my cases so at times I feel I’m not giving the support and education I could and should to families I work with. I would like to have more time to devote to the teen parents who have many struggles to be a good parent and take care of themselves as they try to survive in today’s society.

PHNs desired more time to focus on primary prevention and health promotion. They identified a need for more secondary prevention activities, such as outreach and screening for diabetes, osteoporosis, cholesterol, cancer, blood pressure, hemoglobin, hearing and vision, and growth and development. They also wanted to provide more tertiary prevention, for example, follow-up for specific diseases such as sexually transmitted infections and chronic hepatitis. For specific activities, health teaching and outreach were the most frequently mentioned interventions that PHNs were unable to provide. Other PHNs wanted to provide more social marketing and community presentations, specifically for employers and health care providers. PHNs identified the need to do additional follow-up and interaction with community members about community assessment. Several PHNs also commented on their reduced capacity to conduct home visits in their communities.

Discussion Given the depth and scope of activities and settings for public health nursing practice, PHNs require a

November/December 2015

broad repertoire of knowledge and skills. Both generalist and specialist knowledge and skills are essential for the practice of public health nursing. PHNs need knowledge and skills in both the nursing and public health disciplines (Keller et al., 2004). They are involved in community and work groups both as participants and leaders, which requires expertise in collaboration with professionals in other disciplines and community partners. Many PHN activities are independent practice as indicated by participant responses to their performance of interventions on the survey. Survey results also revealed consistency among PHN activities across the United States. PHNs have an important role in emergency preparedness, prevention of communicable disease, and promotion of family well-being through maternal-child health programs. Overall, PHNs reported involvement in all 10 Essential Public Health Services with a higher percentage of activities that focus on providing information and education. PHNs also practice in all levels of prevention, with a greater percentage of their activities in primary prevention. It is evident that PHNs are doing many activities that prevent disease and contribute to the health of populations. However, their activities are not always visible to the public and decision-makers. Many PHN activities that strengthen social determinants of health are not visible. PHNs helped families to achieve independence in health care decision making, provided education to increase parental knowledge of child growth and development, and advocated for the availability of community health programs. PHNs strengthened the “safety net” for clients when they responded to needs for housing, access to health care, mental health services, and policy enforcement for child and vulnerable adult protection, which all contribute to social determinants of health. Study findings are consistent with the Robert Wood Johnson Foundation (RWJF) analysis of the public health nurse workforce, which distinguished the roles of RNs from other public health staff: (1) PHNs work in all program areas, (2) PHNs provide direct clinical services and health promotion and prevention, (3) PHN clinical knowledge prepares them well for public health interventions, (4) they have a broad perspective on health, (5) they work autonomously and build relationships with partners, and (6) they “work across all lines”

Schaffer et al.: Public Health Nursing Activities and “are the backbone of the health department” (Robert Wood Johnson Foundation, 2013, p. 63). However, a number of PHN activities may be unseen by the public and policymakers. Activities that are counted, documented, and billed are visible. When work is not reimbursable through insurance reimbursement, program fees, or counted by traditional practices such as daily reports, that work may often not be valued because it is unrecognized. Because PHNs aim to empower individuals, families, and communities in decisions and strategies to improve health, their work is often “behind the scenes” as they step back and encourage individuals, families, and communities to take responsibility for health decisions and actions. The sample was not randomly selected. Furthermore, the majority of the sample was baccalaureate prepared and does not reflect the composition of the PHN workforce in all states, with nearly one third at the diploma/associate degree level (Robert Wood Johnson Foundation, 2013). The study highlights PHN perspectives about their work but does not establish a link between PHN activities and population health outcomes. PHNs need to communicate the importance of their work to the public and policymakers responsible for allocating public health funding. Zahner and Gredig (2005) recommended increasing public awareness of what public health nurses do through media and public health messages, emphasizing PHN contributions to public health and the importance of their prevention work. Documentation of interventions and outcomes using clearly understood terminology and identifying relationshipbased public health nursing activities in daily reports is one strategy for measuring what PHNs do. Also, it is important to make known the stories of how PHNs use relationships, collaboration with partners, and their linking and connection work in local media through newspapers, websites, and community events. The Quad Council of Public Health Nursing Organizations (2014) has a responsibility to advocate for making the work of public health nurses visible in the public realm. The knowledge, skills, and expertise that PHNs bring to public health programs and services, not only prevents the suffering of the most vulnerable, but also improves population health and well-being for all.

719

Acknowledgments This paper describes a task analysis of public health nursing activities conducted for the Association of State and Territorial Directors of Nursing (ASTDN), funded by the Centers for Disease Control through a cooperative agreement with the Association of State and Territorial Health Officials (ASTHO).

References American Nurses Association. (2007). Public health nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org. Bekemeier, B., & Jones, M. (2010). Relationships between local public health agency functions and agency leadership and staffing: A look at nurses. Journal of Public Health Management and Practice, 16(2), E8–E16. Clancy, A. (2007). A profession under threat? An exploratory case study of changes in Norwegian public health nursing. International Nursing Review, 54, 197–203. Clancy, A., & Svensson, T. (2009). Perceptions of public health nursing practice by municipal health officials in Norway. Public Health Nursing, 26(5), 412–420. doi:10-1111/j.15251446.2009.00799.x. Clarke, J. (2004). Public health nursing in Ireland: A critical overview. Public Health Nursing, 21(2), 191–198. Gebbie, K. M., & Merrill, J. (2001). Enumeration of the public health workforce: Developing a system. Journal of Public Health Management and Practice, 7(4), 8–16. Grumbach, K., Miller, J., Mertz, E., & Finocchio, L. (2004). How much public health in public health nursing practice? Public Health Nursing, 21(3), 266–276. Hill, W. G., Butterfield, P., & Kuntz, S. (2010). Barriers and facilitators to the incorporation of environmental health into public health nursing practice. Public Health Nursing, 27(2), 121–130. Issel, L. M., Ashley, M., Kirk, H., & Bekemeier, B. (2012). Public health nursing job descriptions: Are they aligned with professional standards? Journal of Public Health Management and Practice, 18(3), E1–E8. Keller, L. O., & Litt, E. A. (2008). Report on public health nurse to population ratio. Columbus, OH: Association of State and Territorial Directors of Nursing (ASTDN). Retrieved from http://phnurse.org/docs/PHN_to_Population_Ratio_2008. pdf/ Keller, L., Strohschein, S., Lia-Hoagberg, B., & Schaffer, M. A. (2004). Population-based public health interventions: Practice-based and evidence-supported. Public Health Nursing, 21(5), 453–468. Keller, L. O., Strohschein, S., & Schaffer, M. A. (2011). Cornerstones of public health nursing. Public Health Nursing, 28(3), 249– 260. Meagher-Stewart, D., Underwood, J., McDonald, M., Schoenfield, B., Blythe, J., Knibbs, K., et al. (2010). Organizational attributes that assure optimal utilization of public health nurses. Public Health Nursing, 27(5), 433–441. doi:10.1111/j.15251446.2010.00876.x. National Association of County and City Health Officials [NACCHO]. (2014). 2013 national profile of local health departments. Retrieved from http://www.naccho.org/topics/infr Nic Philibin, C. A., Griffiths, A. C., Byrne, G., Horan, P., Bardy, A. M., & Begley, C. (2010). The role of the public health nurse in a changing society. Journal of Advanced Nursing, 66(4), 743–752. doi:10.1111/j.1365-2648.2009.05226.x. Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Polivka, B. J., Chaudry, R. V., & Jones, A. (2014). Congruence between position descriptions between public health nursing directors and supervisors with national professional standards and competencies. Journal of Public Health

720

Public Health Nursing

Volume 32

Number 6

Management and Practice, 20(2), 224–235. doi:10.1097/ PHH.Ob013e31829aa2af. Public Health Functions Steering Committee, Members. (1995). Public health in America: Core functions and essential services of public health. Retrieved from http://www.health. gov/phfunctions/public.htm Public Health Nursing Section. (2001). Public health interventions: Applications for public health nursing practice. St. Paul, MN: Minnesota Department of Health. Quad Council of Public Health Nursing Organizations. (2014). Vision and mission. Retrieved from http://quadcouncilphn.org/ Robert Wood Johnson Foundation. (2013). Enumeration and characterization of the public health nurse workforce. Ann Arbor, MI: University of Michigan Center of Excellence in Public Health Workforce Studies. Retrieved from http://www.rwjf.org/ content/dam/farm/reports/reports/2013/rwjf406659

November/December 2015

Schaffer, M. A., Cross, S., Olson, L. O., Nelson, P., Schoon, P. M., & Henton, P. (2011). The Henry Street Consortium population-based competencies for educating public health nursing students. Public Health Nursing, 28(1), 78–90. Smith, K., & Bazini-Barakat, N. (2003). A public health nursing practice model: Melding public health principles with the nursing process. Public Health Nursing, 20(1), 42–48. SmithBattle, L., Diekemper, M., & Leander, S. (2003a). Getting your feet wet: Becoming a public health nurse, Part 1. Public Health Nursing, 21(1), 3–11. SmithBattle, L., Diekemper, M., & Leander, S. (2003b). Moving upstream: Becoming a public health nurse, Part 2. Public Health Nursing, 21(2), 95–102. Zahner, S. J., & Gredig, Q. B. (2005). Public health nursing practice change and recommendations for improvement. Public Health Nursing, 22(5), 422–428.

Public Health Nursing Activities: Visible or Invisible?

To promote visibility of public health nurses (PHNs), this study identified public health nursing activities and explored PHN perceptions of the impac...
264KB Sizes 0 Downloads 6 Views