Essentials of Baccalaureate Nursing Education for Entry‐Level Community/Public Health Nursing

ABSTRACT Community/public health nursing (C/PHN) educators and practitioners need a framework from which to plan, implement, and evaluate curriculum and community‐based practice. The Association of Community Health Nursing Educators (ACHNE) periodically updates the Essentials of Baccalaureate Nursing Education for Entry Level Community/Public Health Nursing to reflect changes in core knowledge, basic competencies, and practice. This update reflects relevance to 21st‐century health care and to national trends influencing nursing education. The 2009 revision is based on critical analysis of key C/PHN literature and input from public health nursing educators and practitioners. A key assumption is that a baccalaureate nursing degree is the minimum requirement for professional C/PHN. Fifteen essential concepts for baccalaureate nursing education are delineated along with related competencies. Newly defined essentials include communication, social justice, and emergency preparedness, response, and recovery. Issues related to didactic and clinical experiences are addressed. The ACHNE Essentials is an important guide for baccalaureate education curriculum planning and evaluation. The Essentials may be useful as a baseline from which to develop competencies of graduate nursing programs. The document is also useful for guiding practice setting orientation and professional development.     

Barriers and Facilitators to the Incorporation of Environmental Health into Public Health Nursing Practice

ABSTRACT Objectives: To describe the environmental health (EH) demands placed on public health nurses (PHNs) as well as the barriers and facilitators to incorporating EH into PHN practice. Design and Sample: A cross‐sectional multimode (Web and pencil/paper) survey was used to collect data from PHNs in 1 rural western state. Research participants included 141 PHNs from a total of 228 survey invitations (61% response). Measures: A 39‐item questionnaire was developed to measure the frequency of EH demands experienced by PHNs as well as the barriers and facilitators to the incorporation of EH into PHN practice and standard demographics. Results: Significant numbers of PHNs reported less than baccalaureate preparation (29%), suggesting that EH competencies cannot be assumed. PHNs are often asked for basic EH information and cite lack of time and lack of interest on the part of the populations being cared for as barriers to incorporating EH into their practice. Facilitators included free or inexpensive continuing education programs offered via the Internet and additional Internet resources or staff resource people. Conclusion: PHNs represent a significant portion of the public health workforce and have implied and explicit mandates to address EH issues in their practice. Resources should be directed toward helping PHNs become better prepared to address the current and future EH needs of populations.     

Using a site visit to a contaminated location as a focus for environmental health education for academic and public health nurses

We describe a conference initiative that is distinguished by the use of a "community case study" to increase the knowledge and skills of nursing faculty and public health nurses in environmental health and to provide networking support to facilitate infusion of environmental health into nursing curricula and public health nursing practice. The Institute of Medicine's (1995) general environmental health competencies for nurses provided the conference framework. Woburn, Massachusetts, a Superfund site, served as the community case study to illustrate a complex environmental health problem. Over an extended period of time, Woburn was contaminated with multiple chemicals that eventually contaminated the drinking water supply; a cluster of childhood leukemia cases was linked subsequently to the Superfund site contaminants. A 6-hr interpreted walking and bus tour of the Superfund site enabled us to visit the premises of responsible parties, the vapor extraction fields, the capped Well H in the wooded wetlands, and to tour the affected neighborhood. This intensive, hands-on approach to learning environmental health content and skills that incorporated multiple learning strategies serves as a model for developing future conferences for public health nurses and nursing faculty.     

Incorporating a built environment module into an accelerated second-degree community health nursing course

ABSTRACT Environmental quality is a leading indicator of population health. Environmental health content has been integrated into the curriculum of an Accelerated Bachelor of Science in Nursing program for second-degree students through development of an environmental health nursing module for the final-semester community health nursing course. The module was developed through collaboration between two professional schools at Duke University (the School of Nursing and the Nicholas School of the Environment and Earth Sciences). It focused on the role of the built environment in community health and featured a mix of teaching strategies, including five components: (1) classroom lecture with associated readings, (2) two rounds of online small-group student discussions, (3) assessment of the built environment in local neighborhoods by student teams, (4) team presentation of the neighborhood assessments, and (5) individual student papers synthesizing the conclusions from all team presentations. The goal of the module was to provide nursing students with an organizing framework for integrating environmental health into clinical practice and an innovative tool for understanding community-level components of public health.     

Challenges and successes of infusing environmental health content in a nursing program

Environmental health has received minimal attention in nursing curricula over the past decade, despite efforts by the Institute of Medicine (1995) and others to advance the environmental health agenda in nursing education, practice, and research. This paper describes an initiative that was first funded as a part of the Environmental Health Scholars Program in 2000 to incorporate environmental health into master's and undergraduate nursing programs at one university. Evaluation of this initiative highlights the challenges and successes experienced in this academic setting. A number of recommendations based on this experience and the literature are offered. There is a perceived need to define the critical body of knowledge and skills in environmental health and to develop tools to enable educators and practitioners to apply this knowledge in public health nursing and other specialty practices. In tandem, opportunities and incentives are needed to encourage faculty development and the infusion of environmental health into existing curricula. Changes are also needed across practice settings to proactively address environmental health issues so that environmental health becomes and remains an integral part of nursing.     

Partnerships for learning population-based public health nursing: Web-delivered continuing education for public health nurse preceptors

Public health and other community health nurses frequently serve as preceptors to undergraduate student nurses learning population-based nursing in community/public health practicum courses. The extent of preparation and support for the preceptor role provided by schools of nursing is often limited. One strategy to address this problem is to provide targeted, Web-delivered continuing education (CE) to preceptors. A Web-delivered CE course entitled, "Partnerships for Learning Community Health Nursing," was created and pilot tested. Course content includes preceptor roles; assisting students in learning population-based public health nursing, critical thinking, and cultural competence; learning styles and teaching strategies; what to do in challenging situations; evaluation and feedback; and specific information about school policies, procedures, and course assignments. Precourse knowledge was assessed using a mailed survey. Postcourse knowledge and satisfaction were assessed using questions embedded in the course. Postsemester knowledge and satisfaction were evaluated through a postsemester survey. Knowledge gain was tested using repeated measures ANOVA and paired t tests. Thirteen preceptors participated in the pilot test. Repeated measures ANOVA indicated that knowledge gain occurred (multivariate F=55.603, df=2, error df=11, p<.0001). Participants increased knowledge from pretest to posttest (t=-10.25, p<.00001) and from pretest to end of the semester (t=-4.95, p<.0003). Knowledge decline from end of course to end of semester was not significant (t=1.94, p=.08). Participants reported satisfaction with the course. Web-delivered CE for community/public health nurse preceptors can support preceptor learning and is an acceptable method for receiving this type of education. Further research is needed on the impact of preceptor education on student learning.     

Open the door whenever opportunity knocks

The Community Environmental Health Program/Community Outreach and Education Program (CEHP/COEP) New Mexico Center for Environmental Health Sciences has learned that listening and responding to opportunities that arise in local communities can be a more effective means of reaching health care providers, lay health workers, and community members than structured plans of action. While specific opportunities that have occurred in New Mexico may be unique, they are presented here with the hope that they might suggest new strategies to the reader and help to identify parallel opportunities in other communities. The paper is organized around three major opportunities to which CEHP/COEP has responded: (1) the need for more informed health care in communities with unique and complex environmental and occupational exposures due to their proximity to National Laboratories; (2) the need for resources on environmental health within local provider networks and issue-specific groups; and (3) the need for community environmental health projects within the College of Nursing. CEHP/COEP's responses, observations, and lessons learned through these experiences are discussed. In the end, the major lesson is that the ability to respond to opportunities requires flexibility and creativity; by sticking doggedly to plans, valuable-and sometimes more profitable and productive-opportunities may be missed.     

Barriers and facilitators in the delivery of environmental risk reduction by public health nurses in the home setting

ABSTRACT Objective: The goal of this study was to identify the factors that contributed to or detracted from the ability of public health nurses (PHNs) to deliver environmental risk reduction (ERR) in the home setting. Design and Sample: Structured one‐to‐one interviews were conducted with 10 PHNs from 2 county health departments in the western United States that were delivering an ERR intervention in a randomized clinical trial. Results: Barriers to incorporating ERR into PHN practice were: a change in the perceived mission of public health, nurses' lack of environmental health (EH) training, the absence of a strong relationship with EH, the multidimensional role of PHNs, presentation of nurse participation by management, incorporation of ERR visits into nursing schedules, and challenges engaging parents in EH. Facilitating factors included: training and support, opportunities for capacity building, belief that ERR is important, building a more visible face for PHN, and personal interest in EH and ERR. Conclusions: Adapting PHN practice to include ERR strategies is feasible, but not without challenges. With adequate training, time, and institutional support, multiple challenges can be overcome. PHNs are well positioned to improve the health of families and communities by integrating ERR into their scope of practice.     

Academic Faculty Qualifications for Community/Public Health Nursing: An Association of Community Health Nursing Educators Position Paper

ABSTRACT The Association of Community Health Nursing Educators (ACHNE) has developed a number of documents designed to delineate the scope and function of community/public health nursing (C/PHN) educators, researchers, and practitioners. Consistent with the mission of ACHNE, this position paper entitled Academic Faculty Qualifications for Community/Public Health Nursing has been developed by the Faculty Qualifications Task Force. The shortage of qualified nursing faculty has been well documented. In particular, this shortage has increased the difficulty in having sufficient numbers of faculty who are educationally and experientially qualified to teach in the C/PHN specialty. ACHNE is addressing this concern by setting forth preferred qualifications for faculty to teach C/PHN at both the graduate and undergraduate level. While we recognize that the current faculty shortage may require schools to use faculty to teach in areas in which they do not have appropriate formal preparation, the paper outlines best practices for teaching C/PHN, a goal we urge all schools of nursing to work toward. Task Force members developed an earlier draft of the document in fall 2008, and input was solicited and received from ACHNE members and considered in the final document, which was approved by the ACHNE Executive Board in July 2009.     

Use of PHN competencies and ACHNE essentials to develop teaching-learning strategies for generalist C/PHN curricula

This paper provides a useful tool for the undergraduate community/public health nursing (C/PHN) faculty member to design courses and learning activities, and to interpret C/PHN education needs to undergraduate curriculum committees and administrators. Specifically, this paper provides a tangible bridge between the Public Health Nursing Competencies (Quad Council of Public Health Nursing Organizations, 2004) and the Association of Community Health Nursing Educators (ACHNE) Essentials of Baccalaureate Education (2000) for both didactic and clinical learning experiences. The tables may be used in multiple ways, including curriculum monitoring and improvement, course development and instructional design, clinical practice planning, and as a foundation for evaluation of conceptual learning and practice competence for the C/PHN generalist. Because C/PHN experiences in undergraduate education are unique and context based, the tables exemplify how two key guiding documents mutually frame the C/PHN educational experience supported by specific learning activities. Further, at a minimum, MSN preparation as a C/PHN specialist is clearly necessary for the teaching and learning of baccalaureate curricular components of C/PHN.