Showing papers in "Public Health Nursing in 2004"

Autonomy and Adolescence: A Concept Analysis

Abstract: During the developmental stage of adolescence, young people strive for independence and begin to make decisions that impact them for the rest of their lives. The purpose of this descriptive study was to examine the literature over the past 15 years to analyze the concept of autonomy in adolescence and to identify possible relationships between autonomy and health behavior. The findings indicate that few studies have been carried out that address the issue of autonomy as it relates to adolescent lifestyles or "ways of living," particularly related to health behaviors. Additional study is warranted to develop more defined theoretical and operational definitions of the concept of autonomy, which will be of value for the development of instruments for measurement and continued research. Furthermore, understanding the antecedents and consequences of adolescent autonomy will facilitate the development of more appropriate health-promoting interventions based on developmental needs.

Population-based public health interventions: practice-based and evidence-supported. Part I.

Abstract: The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing. The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/public health nursing practice, education, and administration. The two articles provide a foundation and vision for population-based public health nursing practice and direction for improving population health.

Organizational structure and job satisfaction in public health nursing

Abstract: The purpose of this descriptive study was to describe the characteristics and relationship of organizational structure and job satisfaction in public health nursing. A significant relationship was found between organizational structure variables and job satisfaction for public health nurses employed in down state Illinois local health departments. The findings of this study suggest that work environments in which supervisors and subordinates consult together concerning job tasks and decisions, and in which individuals are involved with peers in decision making and task definition, are positively related to job satisfaction. This information will assist nurse administrators in development of work structures that support participative decision making and enhance job satisfaction, critical to retaining and attracting a well-qualified public health nurse workforce.

Parenting Stress, Marital Quality, and Child Behavior Problems at Age 7 Years

Abstract: The study examined the relationship of early family environment and infant characteristics with childhood behavior problems at age 7 years. Sixty-two mothers and 56 fathers of preterm (30-36 weeks gestation and greater than 1500 g) and full-term boys and girls completed the Parenting Stress Index, Dyadic Adjustment Scale, and a measure of socioeconomic status during the child's first year. When their child was age 7 years, parents completed the Eyberg Child Behavior Inventory Intensity (frequency of behavior) and Problem (impact of behavior) scales. Hierarchical regression analyses showed that parenting stress because of their child's distractibility during infancy predicted the frequency of childhood behavior problems at age 7 years for mothers and of the impact of behaviors on the mother and the father. The quality of the marital relationship during infancy predicted the frequency of behavior problems reported by fathers. Public health nurses are well positioned to assess parenting stress and marital quality and to provide support to families during the early stages of parenthood.

Nurse home visits to maternal-child clients: a review of intervention research.

Abstract: Home visiting has been considered a promising strategy for addressing the multiple needs of families at risk. Research reviews are a valuable resource for researchers, policymakers, and practitioners who develop and support new home-visiting interventions. This review examines 13 research studies published between the years of 1980 and 2000 that test the effectiveness of home-visiting interventions using professional nurses as home visitors. Findings indicate that a wide range of client problems are addressed during home visits using a variety of nursing interventions. Missing from most of the reports is a clear theoretical link between the client problem addressed, the nursing intervention, and target outcomes. About half of the studies were successful in achieving desired outcomes. Future research should be directed by middle-range practice theory, clearly explicate the nursing intervention being tested, use power analysis to determine sample size, and report reliability and validity of dependent variable measures with culturally diverse samples.

Health Care in Appalachia: A Population-Based Approach

Abstract: The health status of people who live in the rural, coal-producing counties of southwest Virginia remains problematic despite an apparent high primary care provider-to-population threshold. This descriptive exploratory study surveyed 922 households representing 2,188 people, with regard to the availability, need, and access to health care services. Findings indicated a population who had a greater morbidity for chronic illnesses such as heart disease and hypertension than the rest of the state, a large number of people without health and prescription coverage, and an overall perception of fair-to-poor health status. Findings also indicated a substantial proportion of the population who were in need of dental and visual care and general preventive services and those who were dealing with depression at home without outside intervention. One disturbing finding was the large number of people who shared prescriptive medications with family and friends. The Community As Partner Model might be used by community health nurses in this region to help structure interventions. Overall findings suggest a need for interventions aimed at screening for depression, managing prescriptive medications, and identification of low-cost and free preventive, dental, and visual care services.

Physical and psychosocial health in family caregiving: a comparison of AIDS and cancer caregivers.

Abstract: The objectives of this study were to compare cancer and AIDS family caregivers in regard to their physical and emotional health. The sample consisted of 26 caregivers of persons with cancer or AIDS. Study participants completed a questionnaire that included measures of depression, grief, symptoms of stress, caregiving demands, interpersonal relationships, health status, and quality of life. The data revealed that both AIDS and cancer caregivers reported high levels of stress and depression as compared to community norms. No significant differences were found between AIDS and cancer caregivers for any of the scale scores; however, the two groups differed on several individual subscales. Cancer caregivers demonstrated higher social functioning and were more likely to report that the work of caregiving itself disrupted their ability to socially engage with others. In contrast, AIDS caregivers were more likely to report that their own health limited their ability to socialize. Even though AIDS caregivers experienced less family support than cancer caregivers, they reported more rewards from caregiving. Results suggest that support delivered to caregivers emphasize a more inclusive approach to program delivery, versus a disease-specific perspective, in order to increase the depth and breath of services provided to families undertaking these challenges.

Healthy Behaviors and Sources of Health Information Among Low‐Income Pregnant Women

Abstract: This article addresses responses from two open-ended questions, describing the healthy behaviors and sources of health information in 150 low-income pregnant women. Data for this exploratory study were collected as part of a larger descriptive correlational study. Qualitative content analysis was used in the analysis. One hundred fifty English-speaking pregnant women aged 18 and over were interviewed at a public prenatal clinic in the Southeastern United States at their first prenatal visit. Health behaviors were placed into seven mutually exclusive categories: food-related behaviors, substance-related behavior, exercise/rest/activity, self-awareness/appearance, learning, focus on baby, and no specific behaviors. Sources of information questions were placed into seven mutually exclusive categories: family, health personnel, reading, hearing, other people, self-intuitive, and no response. Low-income pregnant women are aware of healthy behaviors and report practicing them during their pregnancies. Because family members are a common source of information for health practices, they should be included in health education efforts.

Comparisons of Motivation, Health Behaviors, and Functional Status Among Elders in Residential Homes in Korea

Abstract: This study compared the changes in health behaviors, motivation, and functional status between motivation enhancement exercise-program participants and program dropouts over 6 months. A total of 73 older adults living in residential homes participated in the study. Face-to-face interviews were conducted at pretest and then at 10 weeks and 6 months in the program. The participants exercised using traditional Korean dance movements for 50 min, 4 times per week, for 6 months. The subjects were classified as participants or dropouts by using a cutoff attendance rate of 80%. Repeated ANOVA revealed the following results over 6 months: 1 The motivation to perform health behaviors, especially for perceived benefits, improved significantly for the participants than for the dropouts. 2 Significant differences in the performance of overall health behaviors and exercise-related behaviors were found between the participants and the dropouts. 3 The sickness impact profile (SIP) of the participants improved significantly, compared with the dropouts. Significant group differences were found for total SIP, physical dimensions, and enjoyment of recreation and pastimes. In conclusion, the study found that the 6-month motivation enhancement program was effective in motivating older adults to perform health behaviors and to improve their functional status.

Effectiveness of home visit falls prevention strategy for Taiwanese community-dwelling elders: Randomized trial

Abstract: The purpose of this research was to examine the effect of a multifactorial intervention to prevent falls by increasing self-efficacy to prevent falls, improving the knowledge of medication safety, and decreasing the number of environmental risks in older persons dwelling in the community. A sample of 120 cognitively intact residents of this community who were 65 years of age and older were recruited into a two-group pretest-post-test experimental design and randomly assigned to an experimental group and a comparison group (60 in each group). The intervention was delivered, and data were collected during three home visits in a 4-month period. (1) Experimental subjects improved their fall self-efficacy, environmental safety, and knowledge of medication safety significantly (p < 0.01) as compared with those in the comparison group at post-test; (2) the incidence of falls was reduced at post-test in both groups compared to pretest scores, and the falling was more serious in the comparison group at post-test compared to that in the experimental group. The results can help community health professionals to individualize their interventions to the specific needs of the elderly, thus helping to prevent falls among community-dwelling elders.

A comparison of health practices of Canadian and Jordanian nursing students.

Abstract: The purpose of this study was to compare health-promoting practices of Canadian (n = 49) and Jordanian (n = 44) first-year nursing students using the revised Health-Promoting Lifestyle Profile II. Results indicated significant differences between the groups on three subscales: health responsibility, physical activity, and interpersonal relations; however, both groups had similarly low scores. Implications for nurse educators are discussed from both curricular and cross-cultural perspective that focuses on health-promotion activities and programs.

The Black–White Perception Gap and Health Disparities Research

Abstract: Reducing and eliminating racial and ethnic health disparities has become a national research priority. This research agenda requires new research frameworks that encompass the social determinants of health and the translation pathways of these social contexts into physiological morbidity. Within these sociobiological research frameworks, identity and emotions are seen as crucial links in the causal pathways from stressors to biological responses. In this country, the lived social reality of African American individuals is experienced through the color of their skin. Their identity is bound with the racial inequities of our society. It has been suggested that the emotions of anger and frustration resulting from this institutionalized racial discrimination are an emotional causative pathway to the pathophysiology contributing to the health disparities experienced by African Americans. However, as much as we espouse the concept of cultural competency in health care, until recently, there has been very little honest dialogue about how race and racism influences health. This article will explore the Black-White cultural perception gap and attempt to provide insight on the relationship to African American health and implications for health disparities research.

Factors Influencing Homelessness in Women

Abstract: The specific aims of the article were to: (i) compare childhood experiences of intimacy and autonomy as they occurred in the families of origin of women who have and women who have not experienced homelessness; (ii) compare social support, reciprocity, and conflict as they occurred in the childhood support networks and in the current support networks of women who have and women who have not experienced homelessness; (iii) examine the relationships between intimacy and autonomy in families of origin and the social support networks from childhood of women who have and women who have not experienced homelessness. Descriptive correlational design: 255 women were interviewed to determine levels of intimacy, autonomy, social support, reciprocity, and conflict in childhood relationships. The ANCOVA models for each of support, reciprocity, and conflict indicated a significant group effect. The post-hoc analysis for support indicated that the homeless group was significantly lower in support and reciprocity and significantly higher in conflict than the never-homeless groups. The never-homeless, never-abused group scored significantly higher on autonomy and intimacy than the homeless or the never-homeless, abused groups. This study demonstrates the significance of families of origin and learning how to develop and utilize support systems in preventing or reducing homelessness.

Family matters: how mothers of adolescent parents experience adolescent pregnancy and parenting.

Abstract: Family support has been demonstrated to be essential for successful long-term outcomes of low-income, African American adolescent mothers and their children [Apfel, N., & Seitz, V. (1996). Urban girls: Resisting stereotypes, creating identities. NY: New York University Press]. Family support may also be essential for the continued paternal involvement of unmarried, low-income, African American adolescent fathers. Twenty mothers of unmarried, low-income, African American adolescent parents were individually interviewed for this qualitative study to describe the experiences of paternal grandmothers (mothers of adolescent fathers) and maternal grandmothers (mothers of adolescent mothers) during transition to fatherhood for unmarried, low-income, African American adolescent fathers. Findings are presented according to the six factors of transition conditions from the nursing model of transitions [Schumacher, K., & Meleis, A. I. (1994). Image, 26, 119-127]: meanings, expectations, level of knowledge and skill, the environment, level of planning, and emotional and physical well-being. Findings indicate that transition to parenthood and grandparenthood is often abrupt and complicated for unmarried, low-income, African American adolescent parents and their families. Paternal and maternal grandmothers continue to act as primary parents for their adolescents while compensating for the lack of skills and attributes for the adolescents' children. Findings from this study can be used to design developmentally and culturally appropriate health care interventions that can support these families during this complex process.

Health Risk Behavior Assessment: Nutrition, Weight, and Tobacco Use in One Urban Seventh-Grade Class

Abstract: Health attitudes and behaviors develop in childhood and progress through adolescence into adulthood. To better understand the health risk behaviors being undertaken by a seventh-grade urban population, a study was conducted to identify what health risk behaviors a group of adolescents were participating in. The purpose of this study was to describe (1) the types of health risk behaviors being undertaken, (2) the frequency of their taking health risk behaviors, and (3) the age of initiation of the health risk behavior. The findings from this study indicate that this sample of 54, urban seventh graders suffers from multidimensional health needs. These students participated in a variety of health risk behaviors, as measured by the Youth Risk Behaviors Surveillance System Questionnaire. These students have begun to smoke regularly, which correlated with the use of alcohol. They rate their health as being good or excellent but rarely met the daily requirements for intake of fruits and vegetables. And, although they rate their weight as being acceptable, most are trying to lose weight. Additionally, differences between the boys and girls were noted in weight perception, with girls more likely than boys to use smoking as the primary method of weight control. Nursing is in an ideal position to provide effective primary care interventions and community health outreach to this adolescent population.

School‐Based Youth Health Nurses: Roles, Responsibilities, Challenges, and Rewards

Abstract: A case study and focus-group discussions were conducted with 10 youth health nurses (nurses) employed in the recently introduced School-Based Youth Health Nurse Program (SBYHNP) to identify their roles, responsibilities, and professional development needs. Major roles are support, referral, health promotion, and marketing. Clients include high school students, teachers, and parents; the majority of whom are female and aged 13-16 years. Health issues addressed during individual consultations are predominantly psychosocial but also include medical, sexual health and sexuality issues, health surveillance, and risk-taking behaviors. Nurses also provide clients with health information and promote enhanced personal skill development during these consultations. Health promotion strategies undertaken by nurses were predominantly health education and health information displays. Nurses reported marketing their role and function within the school to be an essential and often difficult aspect of their role. Professional development through the SBYHNP was excellent; however, there was concern relating to the availability of future educational opportunities. The SBYHNP provides nurses with a new, challenging, autonomous role within the school environment and the opportunity to expand their role to incorporate all aspects of the health-promoting schools' framework.

An Intervention Study to Increase Colorectal Cancer Knowledge and Screening Among Community Elders

Abstract: This study evaluates the effectiveness of a culturally relevant intervention, delivered over 12 months on knowledge of colorectal cancer and participation in fecal occult blood testing. An experimental, repeated measures design was used. Free fecal occult blood testing was offered to the participants. Fifteen senior centers were randomly selected and assigned to the Cultural and Self-Empowerment Group, the Modified Cultural Group, or the Traditional Group. Their mean age was 73.83 years, and their average educational level was 8.8 years. The majority was African American, female, and reported annual incomes < or = 10,000 dollars. Data were collected at baseline, at 6 months, and at 12 months. Participants in the Cultural and Self-Empowerment Group had a significantly greater increase in their knowledge of colorectal cancer over time. Group membership and knowledge of colorectal cancer were significant predictors of participation in colorectal cancer screening. Participants in the Cultural and Self-Empowerment Group and those with greater knowledge of colorectal cancer were more likely to participate in fecal occult blood testing at the end of the 12-month period. Similar strategies may be implemented in community settings and health care agencies to inform elders about colorectal cancer.

Using Geographic Information Systems to Design Population-Based Interventions

Abstract: Geographic information systems (GIS) offer public health nurses a new technology to plan and implement interventions within communities The present article gives a brief overview of GIS, describes a project designed to pilot-test the use of GIS for developing population-based interventions, and discusses lessons learned from the project that need to be applied to any future work Using GIS to map the incidence and prevalence of disease, locate risk factors, and identify access to health care services is not difficult Trying to move beyond that and use the technology to depict community networks and develop and implement population-based interventions is more problematic The project identified specific questions that anyone involved in a planning or decision-making project in which GIS are used should ask

Barriers to effective contraception and strategies for overcoming them among adolescent mothers.

Abstract: Young women often have difficulty accessing and correctly using contraception. However, these difficulties are not primarily the result of lack of knowledge or experience of contraception. In this study, nine adolescent mothers were interviewed about their experience of contraception before and after the birth of their children. These adolescent women faced barriers to effective contraceptive use before the birth of their children. These barriers included indifference to the possibility of pregnancy, perceived invulnerability to pregnancy, and forgetting to use contraception regularly. Analysis also revealed that during the time these women were sexually active prior to pregnancy, many had used a range of strategies to overcome these barriers to effective contraception, including using adult support, allowing an adult to take responsibility for contraception, and using multiple methods of contraception to cover for contraceptive failure. The strategies used by these women to delay childbearing indicate valuable areas for further research in preventing unplanned adolescent pregnancy.

Maternal depression and anxiety and infant development: a comparison of foreign-born and native-born mothers.

Abstract: Studies that investigate infant and/or child development in families of depressed or anxious mothers do not include samples of foreign-born non-English-speaking mothers. This article describes a pilot study investigating infant development, maternal depression, and anxiety in comparison samples of native-born and foreign-born mothers and children from Vietnam, Laos (Hmong), and the Democratic Republic of Congo. Maternal depression and anxiety were measured with the Hopkins Symptom Checklist-25, and the developmental status of children 0-25 months of age was measured with the Denver II. Foreign-born mothers were more anxious than native-born mothers. Non-English-speaking foreign-born mothers were clinically depressed (1.83) and moderately anxious (1.62). Infants of native-born mothers and English-speaking foreign-born mothers performed better on the Denver II than children of foreign-born non-English-speaking mothers. Infants and toddlers of non-English-speaking mothers appear to be at high risk for delays during their first 25 months of life. Public health nurses need to advocate for appropriate interpreter services and mental health resources for non-English-speaking mothers of young children. Developmental screening should reflect cultural variations in parental expectations of how and when children meet developmental milestones. Replication studies and investigation about the long-term development of this high-risk group of children are needed.

Public health education and practice using geographic information system technology.

Abstract: The use of geographic information system (GIS) technology allows public health practitioners to explore disparities in health, analyze disease outbreaks, and prioritize the use of limited resources for improving population health. Nursing students benefit from use of World Wide Web GIS resources as they develop knowledge and skill in assessing population health and planning interventions. This article identifies the benefits of GIS for public health practitioners, presents a communicable disease control application of GIS, and discusses a GIS module used in an undergraduate nursing education course. Uniform standards for making health data available for public use with GIS are discussed.

Influences on adolescent self-esteem in multicultural Canadian secondary schools.

Abstract: This study examined the global and current self-esteem levels of adolescents in a community sample of 550 secondary school students in Canada. A cross-sectional design and the survey method were used. Respondents' individual (age and gender) and environmental (cultural background, acculturating group, family circumstances, and perception of support) attributes were considered. Influences that promoted or challenged their current self-esteem were examined. Eighteen percent of respondents and 43.4% of respondents' parents were immigrants. When the Rosenberg Self-Esteem scale was used, 27.6% of respondents had the highest global self-esteem level; when the Current Self-Esteem scale was used, 12.7% had the highest current self-esteem level. A significant gender difference was found, with male adolescents having higher self-esteem. The results indicate that, although self-esteem promotion can benefit from lifestyle-oriented activities, its growth takes place in the larger context of adolescents' relationships, school-related experiences, achievements, and attitudes toward themselves. The study findings can contribute to mental health promotion strategies in multicultural and immigrant-receiving community settings.

Personal narratives of adolescent mothers-to-be: contraception, decision making, and future expectations.

Abstract: Results not discussed in a previously published qualitative study (Spear, 2001) are presented in this article. Analysis of the personal narratives of eight pregnant adolescents who attended an alternative school for pregnant teens yielded the following categories: decision making, contraceptive behavior and sexual attitudes, and future expectations. The findings revealed that decisions regarding pregnancy were made with little deliberation and some participants implied that pregnancy was planned. Although knowledgeable about how to prevent pregnancy, participants did not consistently practice contraception and their sexual experiences were marked by indifference and lacked intimacy. Future expectations consistently included support from the fathers of their unborn children. Implications for nursing practice and further research are discussed.

The Interaction Model of Client Health Behavior as a conceptual guide in the explanation of children's health behaviors.

Abstract: This study used the Interaction Model of Client Health Behavior (IMCHB) as a conceptual guide to explain the correlates of children's diet and physical activity and explore the relationships of sex with their diet and physical activity of the school-aged child. A descriptive correlational study was conducted on 371 fifth-grade students and their parents. Information on the family's demographics, health experience, social influence, and environmental resources was collected, as well as data on the children's intrinsic motivation, cognitive appraisal, and affective response to food/physical activity. Children's self-reports on diet and physical activity were collected, as were parents' self-reports on health habits. Food preferences and diet self-efficacy explained the most variance in diet behavior for girls and boys. Girls scored healthier on food preferences and diet self-efficacy than did boys, but no difference was detected in their diet behavior. Girls participated in more low-intensity physical activity, but boys participated in more high-intensity physical activity than did girls. Findings provide strong support for the use of the IMCHB to explain children's diet but weak support for the explanation of children's physical activity. Further study of additional factors predictive of physical activity is indicated.

Essential concepts in developing community-university partnerships. CareLink: the Partners in Caring Model.

Abstract: University and community partnerships are being created to increase community-based educational experiences for nursing students and to assist agencies in facing ever-decreasing resources to pay for health services for clients. Many challenges often burden these partnerships, leading to a less than satisfying experience for all those involved. The Partners in Caring Model described in this article is one approach to forming a successful partnership, proven effective in meeting the educational needs of the University of Connecticut, School of Nursing students, while providing additional resources to the Visiting Nurse Association of Central Connecticut, Inc. Using Anderson and McFarlane's Community as Partner Model as the framework, the essential principles behind the development of this successful partnership are discussed. The Partners in Caring Model demonstrates that community-university partnerships can sustain themselves when the partners have a commitment to care for the population being served, and it is a shared responsibility between education and practice.

Childhood vaccine risk/benefit communication among public health clinics: a time-motion study.

Abstract: United States law requires that immunization providers use Centers for Disease Control Vaccine Information Statements (VISs) and inform parents about vaccine risks and benefits prior to every childhood immunization. A recent national survey found that public health clinics (PHCs) reported high compliance with this law. To further investigate these findings, we conducted an immunization time-motion study in two PHCs in Kansas and Louisiana. Research assistants observed a convenience sample of 246 child immunization visits to record distribution of the VISs and content and time of vaccine communication. Thirty percent of parents read below a ninth grade level, 53% had Medicaid insurance, and 56% were Black. VISs were given with every dose of vaccine administered in 89% of visits. Public health nurses (PHNs) frequently discussed potential vaccine side effects (91%), treatment of side effects (91%), and the vaccine schedule (93%). Contraindications were screened in 71% of visits. Benefits were discussed in 48% of visits and severe risks in 29%. The national Vaccine Injury Compensation Program (VICP) was never discussed. The immunization visits lasted for a mean of 20 min. Vaccine communication of side effects, risks, benefits, screening for contraindications, and the next visit lasted for an average of 16 s for all vaccines. PHC compliance with mandated VIS distribution and practical vaccine communication was high. Room for improvement exists in discussion of benefits, serious risks, and the VICP.

Health care needs of elderly in a rural community in Korea.

Abstract: The purpose of this study was to examine the need for health and social support services of the elderly who lived alone in a rural community in Korea. All 97 elderly who lived alone in 32 communities in H Eub(county), Kangwon Province participated in the study. Comprehensive assessment was conducted on their need for these services and on the status of their physical, functional, cognitive, emotional, nutritional, social, and environmental factors. Data were collected by eight public health nurses and were analyzed using descriptive statistics and stepwise multiple regression. Elderly subjects living alone had more than one disease, limited gait ability, limited functional capabilities as measured by the combination of activities of daily living and instrumental activities of daily living, and poor nutritional state. They had low level of cognitive ability, high level of depression, and high level of need for financial support. They engaged in no or little exercise. Service need for physical care was highest, and the factors contributing to the service need were gait ability, functional capabilities, nutrition state, and perceived health status. The results of this study indicate that their needs are multiple and complex. Well-coordinated health services that integrate social welfare services for elderly population who live alone are recommended.

How much public health in public health nursing practice

Abstract: Public health nursing (PHN) practice is defined by an emphasis on population health issues rather than individually focused clinical interventions, but the actual scope and focus of PHN practice have not been well documented. The purpose of this survey was to investigate the practice activities, priorities, and education of public health nurses in California. Public health nurses in five counties were surveyed about interventions targeted at individual-family, community, and system levels. Summary scales (range: 1-4) were created to measure self-rated PHN activity, importance, and education at each level. Staff were most likely to perform individual-family level interventions (mean score, m=2.55), followed by community (m=1.86) and system-level interventions (m=1.46). Managers rated individual-family level interventions as most important (m=2.91) and community-level interventions (m=2.42) as more important than those at the system level (m=1.99). Individually focused case management was the most frequently performed and highly valued intervention. Staff and manager-directors deemed individual-family interventions as the area in which public health nurses were best educated, followed by community and then system interventions. Results indicate that the population health focus of public health nursing is not reflected in the practice activities, management priorities, or educational preparation of public health nurses.

The Efficacy of a Home-Based Nursing Program in Diabetic Control of Elderly People with Diabetes Mellitus Living Alone

Abstract: The purpose of this study was to evaluate the efficacy of a home-based nursing program in the diabetic control of elderly people with diabetes mellitus living alone. Patients meeting the sampling criteria were recruited from a medical center and 10 health centers in Taipei for this quasi-experimental study. By matching the effects of age, sex, education, and history of diabetes, subjects were assigned semirandomly to two groups based on the intensity of home-based nursing care visitations. Group I was defined as daily visits to supervise diet, exercise, medication, and self-monitoring blood sugar (n = 15) and Group II as weekly visits to supervise diet, exercise, medication education, and self-monitoring blood sugar (n = 15). Patients who agreed only to receive blood examination were assigned to the control group (n = 14). The results of the study showed that reductions in fasting blood sugar, postmeal blood sugar, and hemoglobin A1c (HbA1c) in Groups I and II were significantly greater than those in the control group. The reduction in the total cholesterol and low-density lipoprotein in Groups I and II was significantly greater than that in the control group. There were no significant differences among the three groups in the improvement of high-density lipoprotein (HDL) and triglycerides (TGs). Group I revealed a significantly greater weight reduction compared to Group II. There was no significant difference between Groups I and II in the improvements of diabetes knowledge, depression level, or quality of life. From the research findings, based on cost-effectiveness, it is recommend that Program II be implemented.

Population-based public health interventions: innovations in practice, teaching, and management. Part II.

Abstract: The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing (PHN). The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/PHN practice, education, and administration. The two articles provide a foundation and vision for population-based PHN practice and direction for improving population health.