Search

Background: Public Health Nurses (PHN) caring for vulnerable populations amid systemic inequality must navigate complex situations, and consequently they may experience serious moral distress known to be detrimental to PHN wellbeing., Objective: Given PHN awareness of social inequities, the study aimed to determine if PHNs were motivated to enact social change and engage in social and political action to address inequality., Design and Sample: A survey of 173 PHNs was conducted in fall 2022. The convenience sample was mainly female (96.5%), White (85%), had associate/bachelor's degrees (71.7%), and worked in governmental public health settings (70.7%)., Measure: The study employed the Short Critical Consciousness Scales' subscales: Critical Reflection, Critical Motivation, and Critical Action., Results: PHNs were highly motivated to address inequities (Critical Motivation = 20.83; SD = 3.16), with similarly high awareness (Critical Reflection = 17.89; SD = 5.18). However, social and political action scores were much lower (Critical Action = 7.13; SD = 2.63). A subgroup of PHNs with strong agreement regarding the impact of poverty were more likely to be younger (p = .039) and work in a community setting (p = .003); with higher scores across subscales (p < .001)., Conclusions: High critical reflection and motivation among PHNs aligned with literature. Lower Critical Action scores warrant investigation into validity for PHNs, and possible role constraints., (© 2023 The Authors. Public Health Nursing published by Wiley Periodicals LLC.) more...

Objective: To characterize patterns in whole-person health of public health nurses (PHNs)., Design and Sample: Survey of a convenience sample of PHNs (n = 132) in 2022. PHNs self-identified as female (96.2%), white (86.4%), between the ages 25-44 (54.5%) and 45-64 (40.2%), had bachelor's degrees (65.9%) and incomes of $50-75,000 (30.3%) and $75-100,000/year (29.5%)., Measurements: Simplified Omaha System Terms (SOST) within the MyStrengths+MyHealth assessment of whole-person health (strengths, challenges, and needs) across Environmental, Psychosocial, Physiological, and Health-related Behaviors domains., Results: PHNs had more strengths than challenges; and more challenges than needs. Four patterns were discovered: (1) inverse relationship between strengths and challenges/needs; (2) Many strengths; (3) High needs in Income; (4) Fewest strengths in Sleeping, Emotions, Nutrition, and Exercise. PHNs with Income as a strength (n = 79) had more strengths (t = 5.570, p < .001); fewer challenges (t = -5.270, p < .001) and needs (t = -3.659, p < .001) compared to others (n = 53)., Conclusions: PHNs had many strengths compared to previous research with other samples, despite concerning patterns of challenges and needs. Most PHN whole-person health patterns aligned with previous literature. Further research is needed to validate and extend these findings toward improving PHN health., (© 2023 The Authors. Public Health Nursing published by Wiley Periodicals LLC.) more...

Objectives: In this study we aimed to describe and compare groups formed by a rules-based algorithm to prospectively identify clients at risk of poor outcomes in order to guide tailored public health nursing (PHN) intervention approaches., Design: Data-driven methods using standardized Omaha System PHN documentation., Sample: Clients ages 13-40 who received PHN home visiting services for both the Caretaking/parenting and Mental health problems (N = 4109)., Measurement: We applied a theory-based algorithm consisting of six rules using existing Omaha System data. We examined the groups formed by the algorithm using standard descriptive, inferential statistics, and Latent Class Analysis., Results: Clients (N = 4109) were 25.1 (SD = 5.9) years old and had an average of 7.3 (SD = 3.2) problems, 250 (SD = 319) total interventions, and 32 (SD = 44) Mental health interventions. Overall outcomes improved after PHN interventions (p < .001 for all) and having more Mental health signs/symptoms was negatively associated with outcome scores (p < .001 for all)., Conclusions: This algorithm may be helpful in identifying high-risk clients during a baseline assessment who may benefit from more intensive mental health interventions. Findings show there is value using the Omaha System for PHN documentation and algorithm clinical decision support development. Future research should focus on algorithm implementation in PHN clinical practice., (© 2023 The Authors. Public Health Nursing published by Wiley Periodicals LLC.) more...

Objectives: Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States., Design: Secondary data analysis of the 2018 National Sample Survey of Registered Nurses., Sample: Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce., Measurements: Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed., Results: Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting., Conclusions: Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice., (© 2023 Wiley Periodicals LLC.) more...

Objectives: The purpose was to determine the feasibility of using a standardized language, the Omaha System, to describe community-level strengths. The objectives were: (a) to evaluate the feasibility of using the Omaha System at the community level to reflect community strengths and (b) to describe preliminary results of community strengths observations across international settings., Design and Sample: A descriptive qualitative design was used. The sample was a data set of 284 windshield surveys by nursing students in 5 countries: Mexico, New Zealand, Norway, Turkey, and the United States., Measures: An online survey included a checklist and open-ended questions on community strengths for 11 concepts of the Omaha System Problem Classification Scheme: Income, Sanitation, Residence, Neighborhood/workplace safety, Communication with community resources, Social contact, Interpersonal relationship, Spirituality, Nutrition, Substance use, and Health care supervision. Themes were derived through content analysis of responses to the open-ended questions., Results: Feasibility was demonstrated: Students were able to use the Omaha System terms and collect data on strengths. Common themes were described among the five countries., Conclusions: The Omaha System appears to be useful in documenting community-level strengths. Themes and exemplar quotes provide a first step in developing operational definitions of strengths at a more granular level., (© 2018 Wiley Periodicals, Inc.) more...

Objective: To examine associations of data-driven intervention approaches (IAs) with the outcomes of adolescent or adult Latina mothers with or without the Mental health problem., Design and Sample: Retrospective observational study using public health nurse (PHN)-generated data for 676 Latina mothers aged 14-52., Measures: Mothers' age, having the Mental health problem, number of problems and interventions, and Knowledge, Behavior, and Status scores using the Omaha System. Mother-specific percentages of interventions to the total number received were calculated. Visualizations and statistical tests were used to analyze the association of IAs relating mothers' characteristics, problems, interventions, and outcomes., Results: Four IAs were discovered. Sample characteristics differed significantly among IAs by age and having the Mental health problems. There was a small effect of age on outcomes (<0.10). PHNs differentially addressed problems in IA1-IA4 compared with IA2-IA3 (p < 0.001). Mothers who received IA3 had the most improvement and highest scores in Knowledge and Behavior (all p < 0.001). Mothers who received IA2 had the most improvement and highest scores in Status (both p < 0.001)., Conclusions: The IAs were associated with outcomes differentially among Latina mothers, depending on multiple complex factors. These methods may be useful in understanding intervention tailoring and should be replicated with other populations and datasets., (© 2018 Wiley Periodicals, Inc.) more...

Objective(s): The purpose of this manuscript was to describe: Public Health Nurse (PHN) home-visited, female client Nutrition Knowledge (K), Behavior (B), and Status (S); the number and types of nutrition interventions PHNs used with these clients; and the types of clients receiving nutrition interventions., Design and Sample: This descriptive study used PHN-generated Omaha System, electronic health record data from January 2012 to July 2015. The analytic sample contains 558 women who received home visits in a rural Midwestern U.S. county that employed universal nutrition assessment for clients., Measurements: Omaha System data included nutrition KBS scores (from 1 = low to 5 = high) and nutrition interventions delivered. Analyses included descriptive, bivariate, and multivariate analyses (means, frequencies, chi-squares, general linear models)., Results: PHNs assessed nutrition KBS scores for 84.1% of clients; average Nutrition Knowledge was 3.4 (SD = 0.7), Behavior 3.7 (SD = 0.8), and Status 4.3 (SD = 1.0). PHNs provided 0-36 nutrition interventions per client. Nutrition intervention patterns were detected by the type of visit clients received., Conclusions: Results suggest home-visited women have room to improve Nutrition KBS and PHNs utilize myriad nutrition interventions. Results also point to opportunities to improve home-visited client care by providing more nutrition interventions, especially to those not receiving interventions, and revising standard care plans to reflect important Case Management nutrition interventions., (© 2018 Wiley Periodicals, Inc.) more...

Objective(s): Examine factors related to physical activity among rural women using Omaha System data., Design and Sample: Mixed methods: quantitative analysis of de-identified clinical data and thematic analysis of public health nurse (PHN) focus group data. Rural women who received PHN services (N = 852) and purposively selected PHNs (N = 12)., Measures: Omaha System problems; signs/symptoms; knowledge, behavior, and status ratings; demographics., Results: Physical activity behavior among rural women was inconsistently appropriate (M = 3.27). Age, body mass index, physiological, psychosocial, and environmental domain problems, and physical activity knowledge explained 33.2% of physical activity behavior variance. Almost all women for whom specific problems were documented had insufficient physical activity. This included physiological problems of cognition and pregnancy; psychosocial problems of abuse, caretaking/parenting, mental health, and interpersonal relationship; and environmental problems of neighborhood/workplace safety and income. Having problems in two or more domains was significantly associated with insufficient physical activity behavior (p < .001). PHNs validated findings and expressed concerns that client complexity, priorities, and time constraints may affect client assessment and documentation., Conclusions: PHNs should assess rural women who are not physically active for potentially serious physiological, psychosocial, and environmental problems. Departmental policies requiring assessment of Omaha System data across programs enabled population health measurement and research., (© 2016 Wiley Periodicals, Inc.) more...

Physical inactivity is a global health problem. Public health nurses (PHNs) have great potential to influence population health outcomes in this area. However, methods are needed to increase understanding of the problem and the impact PHNs may have on measuring and changing health behavior. One promising option is PHN documentation of client health data. However, literature examining how health behavior theories align with nursing documentation systems that use standardized terminology is sparse. The purpose of this article was to operationalize an ecological theory with the Omaha System standardized terminology using physical activity as an exemplar. The goal was to provide a method for using PHN clinical documentation to examine physical activity from a theoretical perspective in research and practice. We designed and used a three-phase process informed by the literature to conceptually map the ecological model for health promotion and the Omaha System. The results of the mapping process reveal the ecological nature of the Omaha System and provide support for measuring and analyzing health-related behavior problems from an ecological perspective with Omaha System data. This process could be replicated with other health-related problems and standardized terminologies to guide theoretically based nursing care and research., (© 2016 Wiley Periodicals, Inc.) more...

Objectives: The purpose of this study was to determine the feasibility of using a standardized language, the Omaha System, to capture community-level observations to facilitate population assessment and electronic information exchange. The objectives were: (1) to evaluate the feasibility of using the Omaha System at the community level to reflect community observations and (2) to describe preliminary results of community observations across international settings., Design and Sample: Descriptive. A dataset of 284 windshield surveys (community observations) completed by nursing students in five countries: Mexico, New Zealand, Norway, Turkey, and the United States., Measures: The Omaha System Problem Classification Scheme provided standardized terms for assessment of communities in an online checklist of 11 problems and their respective signs/symptoms., Results: Feasibility was demonstrated: students were able to describe community observations using standardized terminology from the Omaha System. Preliminary results describe variations in community signs and symptoms by location., Conclusions: The Omaha System appears to be a useful tool for community-level observations and a promising strategy for electronic exchange of population health assessments., (© 2015 Wiley Periodicals, Inc.) more...

Objective(s): A public health nurse (PHN) in the Midwestern United States (U.S.) led a collaborative system-level intervention to translate the Institute of Clinical Systems Improvement (ICSI) Adult Obesity Guideline into interprofessional practice. This study (1) evaluated the extent of guideline translation across organizations and (2) assessed the Omaha System as a method for translating system-level interventions and measuring outcomes., Design and Sample: This retrospective, mixed methods study was conducted with a purposeful sample of one administrator (n = 10) and two to three clinicians (n = 29) from each organization (n = 10)., Measures: Omaha System Problem Rating Scale for Outcomes Knowledge, Behavior, and Status (KBS). KBS ratings gathered from semi-structured interviews and Omaha System documentation were analyzed using standard descriptive and inferential statistics and triangulated findings with participant quotes., Results: KBS ratings and participant quotes revealed intervention effectiveness in creating sustained system-level changes. Self-reported and observed KBS ratings demonstrated improvement across organizations. There was moderate to substantial agreement regarding benchmark attainment within organizations. On average, self-reported improvement exceeded observer improvement., Conclusions: System-level PHN practice facilitator interventions successfully translated clinical obesity guidelines into interprofessional use in health care organizations. The Omaha System Problem Rating Scale for Outcomes reliably measured system-level outcomes., (© 2014 Wiley Periodicals, Inc.) more...

Objectives: To evaluate variability in health literacy outcomes due to home visiting (HV) program components including PHN, Intervention, and Client., Design and Sample: A comparative, correlational study evaluated PHN home visiting program data that included PHNs (N = 16); Interventions (N = 21,634); and Clients (N = 141). Client age ranged from 14 to 46 (median = 21, mean = 22.8, SD = 6.65). Clients were predominately White (75.9%), not married (84.4%), and female (99.3%). PHNS documented care using electronic health records (EHR) and the Omaha System., Measures: The outcome of interest was health literacy benchmark attainment (adequate knowledge) operationalized by Omaha System Problem Rating Scale for Outcomes Knowledge scores averaged across problems., Intervention: Program of individually tailored, evidence-based HV interventions provided by PHNs., Results: There were 233 different interventions for 22 problems. Knowledge benchmark was attained by 16.3% of clients. Four factors explained variance in reaching the knowledge benchmark: Client (51%), Problem (17%), Intervention (16%), and PHN (16%)., Conclusions: The PHN and intervention tailoring are actionable components of HV programs that explain variability in health literacy outcomes. Further research should examine effects of training on PHN relationship skills and intervention tailoring to optimize outcomes of evidence-based PHN HV programs, and to evaluate whether improving health literacy may subsequently improve client problems., (© 2014 Wiley Periodicals, Inc.) more...

Objective: The purpose of the study was to investigate the perceptions of administrators and clinicians regarding a public health facilitated collaborative supporting the translation into practice of the Institute for Clinical Systems Improvement (ICSI) Adult Obesity Guideline., Design and Sample: This qualitative study was conducted with 10 health care organizations participating in a voluntary, interprofessional obesity management collaborative. A purposive sample of 39 participants included two to three clinicians and an administrator from each organization. Interview analysis focused on how the intervention affected participants and their practices., Results: Four themes described participant experiences of obesity guideline translation: (1) a shift from powerlessness to positive motivation, (2) heightened awareness coupled with improved capacity to respond, (3) personal ownership and use of creativity, and (4) a sense of the importance of increased interprofessional collaboration., Conclusions: The investigation of interprofessional perspectives illuminates the feelings and perceptions of clinician and administrator participants regarding obesity practice guideline translation. These themes suggest that positive motivation, improved capacity, personal creative ownership, and interprofessional collaboration may be conducive to successful evidence-based obesity guideline implementation. Further research is needed to evaluate these findings relative to translating the ICSI obesity guideline and other guidelines into practice in diverse clinical settings., (© 2014 Wiley Periodicals, Inc.) more...

An invited group of national public health nursing (PHN) scholars, practitioners, policymakers, and other stakeholders met in October 2010 identifying a critical need for a national PHN data infrastructure to support PHN research. This article summarizes the strengths, limitations, and gaps specific to PHN data and proposes a research agenda for development of a PHN data infrastructure. Future implications are suggested, such as issues related to the development of the proposed PHN data infrastructure and future research possibilities enabled by the infrastructure. Such a data infrastructure has potential to improve accountability and measurement, to demonstrate the value of PHN services, and to improve population health., (© 2012 Wiley Periodicals, Inc.) more...

Objectives: Benchmark client outcomes across public health nursing (PHN) agencies using Omaha System knowledge, behavior, and status ratings as benchmarking metrics., Design and Sample: A descriptive, comparative study of benchmark attainment for a retrospective cohort of PHN clients (low-income, high-risk parents, primarily mothers) from 6 counties., Measures: Omaha System Problem Rating Scale for Outcomes data for selected problems. Benchmark measures were defined as a rating of 4 on a scale from 1 (lowest) to 5 (highest)., Intervention: Family home visiting services to low-income, high-risk parents., Results: The highest percentage of benchmark attainment was for the Postpartum problem (knowledge, 76.2%; behavior, 94.0%; status, 96.6%), and the lowest was for the Interpersonal relationship problem (knowledge, 21.7%; behavior, 69.0%; status, 40.7%). All counties showed significant increases in client knowledge benchmark attainment, and 4 of 6 counties showed significant increases from baseline in behavior and status benchmark attainment. Significant differences were found between counties in client characteristics and benchmark attainment for knowledge, behavior, and status outcomes., Conclusions: There were consistent patterns in benchmark attainment and outcome improvement across counties and family home visiting studies. Benchmarking appears to be useful for comparison of population health status and home visiting program outcomes., (© 2011 Wiley Periodicals, Inc.) more...

Objective: To test the feasibility of representing public health nurse (PHN) manager interventions using a recognized standardized nursing terminology., Design and Sample: A nurse manager in a Midwest local public health agency documented nurse manager interventions using the Omaha System for 5 months. ANALYTIC STRATEGY: The data were analyzed and the results were compared with the results from a parallel analysis of existing PHN intervention data., Results: Interventions for 79 "clients" (projects, teams, or individuals) captured 76% of recorded work hours, and addressed 43% of Omaha System problems. Most problems were addressed at the "community" level (87.1%) versus the "individual" level (12.9%)., Conclusions: Nursing practice differed between the 2 knowledge domains of public health family home visiting nursing and public health nursing management. Standardized nursing terminologies have the potential to represent, describe, and quantify nurse manager interventions for future evaluation and research., (© 2011 Wiley Periodicals, Inc.) more...

Objectives: To use structured clinical data from public health nurse (PHN) documentation to describe client risk, to describe family home visiting interventions, including tailoring, and to assess the associations between client risk and intervention tailoring., Design and Sample: Retrospective cohort design. A cohort of 486 family home visiting clients who received at least 3 visits from PHNs in a local Midwest public health agency (2000-2005)., Measures: Omaha System variables documenting assessments, interventions, and outcomes. A risk index was created to identify low- and high-risk clients. Descriptive and inferential methods were used to describe interventions, and to assess intervention tailoring between groups., Intervention: Routine PHN family home visiting practice., Results: The risk index meaningfully discriminated between groups. PHNs provided more visits and interventions to clients in the high-risk group, with variations in problem, category, and target by group, demonstrating that PHNs tailored interventions to address specific client needs., Conclusions: Standardized terminologies and structured clinical data are useful tools to support PHN practice, and may be useful to advance health care quality research, program evaluation, policy development, and population health outcomes., (© 2011 Wiley Periodicals, Inc.) more...

Pediculosis is a population-based problem that is a priority concern for many communities. Public health nurses in a county health department collaborated with epidemiologists, nursing students, and faculty to design and implement an effective population-based pediculosis management project. The focus of the project was the development of pediculosis treatment and prevention guidelines based on recognized best practices that were acceptable to both epidemiologists and practicing public health nurses. Public health nurses disseminated these guidelines to community providers and reinforced their use through consultation and educational sessions. Two critical changes occurred as a result of the project. First, community providers significantly changed their recommendations for the treatment of pediculosis after nursing intervention. Second, public health nurses increased their population-based practice skills, continued to use those skills to address pediculosis, and extended those skills to additional population-based initiatives. more...