In Collaboration with: Pat McLaine, DrPH, MPH, RN

Problem Statement:  As the US health care and economic landscape changes, comprehensive and reliable granular level workforce data are critical to plan for service delivery. In order to improve population health outcomes, health equity and control health costs, it is critical to have an adequate and competent workforce. Public health nurses (PHN’s) have successfully provided essential population-based services for decades but their recent work has largely been invisible. The future of public health nursing is in question, as the workforce ages and shrinks. Data on the state of the PHN workforce in Maryland are not available. The workforce also faces many challenges: funding cuts, low salaries, hiring and retention barriers, low interest from new graduates, and replacement of nursing positions with non-nurses. To remain viable and visible, PHN’s must take credit for their work and contributions to the health of their communities.

Approach: We contacted PHN leaders from Maryland’s 24 local health departments (LHD’s) to participate in an interview to enumerate and characterize their PHN’s, including school health nurses. In addition, we asked the PHN leaders to disseminate an online survey to their PHN’s. The study was reviewed and exempted by the University of Maryland IRB.

Products/Outcome: 19 LHD’s participated in the interviews and over 500 PHN’s participated in the online survey. Findings include the education, age, work settings, and salaries of PHN’s, perceived barriers to practice, strategies to promote the profession, and knowledge of key “Future of Nursing Campaign” initiatives. PHN leaders also identified several PHN initiatives that reduced health care costs and improved health outcomes.

Implications: Strategic efforts and political will are needed to ensure that policymakers recognize the assets of the PHN workforce and include PHN’s in plans to deliver critical population-based and public health services. PHN’s must also improve the visibility of successful programs and outcomes and widely disseminate their contributions in community publications and peer-reviewed literature.

The post Enumerating and Characterizing Maryland’s Public Health Nursing Workforce: appeared first on Campaign for Action.

In Collaboration with: Maren J. Coffman, PhD, RN, CNE

Problem Statement: Post-partum depression is a common condition impacting 3 million (7% of) women with infants in the U.S every year. The purpose of this study was to gain a better understanding of the prevalence of post-partum depression (PPD) among mothers visiting WIC clinics in Mecklenburg County Public Health, and provide referrals for women experiencing depression symptoms. A secondary purpose was to understand the motives and barriers for seeking treatment, and the support systems that mothers find most useful.

Approach: Mothers with infants under 1 year of age were screened for depression risk and depressive symptomatology using the Patient Health Questionnaire 2 (PHQ2). Mothers who scored ³ 2 on the PHQ2 were then asked to complete two additional screening tools: the Patient Health Questionnaire 9 (PHQ9) and Edinburgh Postnatal Depression Scale. If indicated, the mother was referred for case management services. A follow up survey was collected 3 to 4 weeks after the initial survey to assess treatment outcomes.

Products/Outcome: Surveys have been collected in two WIC clinics (n = 122; 60% in English and 40% in Spanish). According to preliminary results, 20% of mothers screened were at risk for post-partum depression (PHQ2 ³ 2, history of depression). Eight mothers completed the PHQ9 and Edinburgh, and 6 of those were at risk for clinical depression. Referrals were made to a case manager to provide support, assess the health of the infant, and refer to clinical services. Screening is ongoing and future participants will be offered a $25 gift card to complete the survey.

Implications: Early detection and treatment has been shown to improve outcomes for both the mother and the child. Women who participate in WIC may be at higher risk for post-partum depression, and screening is essential in order to identify those with depressive symptoms. This project demonstrates the importance of identifying women at risk, providing treatment options, and understanding support systems.

The post Postpartum Depression Screening in a Community-Based Sample of Mothers appeared first on Campaign for Action.

Approach: A survey was conducted at the New York State Action Coalition’s booth at the Great New York State Fair. This anonymous survey assessed two domains: individual health behaviors and activities of community engagement. Discussions regarding the role of nursing and health were ongoing between fair goers and the volunteer nurses who staffed the booth during 12 days of August/September 2016.   The survey findings represent a convenience sample of 326 adults with nurses representing 33.4% of participants.  Survey participants identified as White (86.2%), Black (8.6%), Hispanic (3.1%), Native American (3.4%), and Asian (2.2%). Nearly 80% of the participants identified as female and 47.5% indicated at least a Bachelor’s degree or higher education.

Products/Outcome: Nurses are more likely to participate in healthy behaviors and community engagement activities as compared to other survey participants.  Most survey participants, including nurses, do not eat the recommended amount of 5 cups of fruits and vegetables per day, nor sleep the recommended 7 to 8 hours per night.  Only 20% of the nurse survey participants strongly agree their life is in balance. Contribution of time or money to a health-related organization is the most common community engagement activity for all survey participants.

Implications: Nurses have opportunities to build a Culture of Health through personal and professional activities, collaborations with community stakeholders, and community engagement. The findings of this survey suggest areas to improve individual and community health.  The survey also reveals a need to reach a more diverse audience.

The post Healthy Communities and You, a Culture of Health Survey at the 2016 New York State Fair appeared first on Campaign for Action.

Problem Statement: The current period, from the passage of the Affordable Care Act in 2010 to the present, is characterized by intense change in the health care system, including changes in the health care workforce.  The nursing profession has a long and credible history developing the workforce to meet health needs of the population.  Active engagement of nurses in health systems transformation is necessary if nurses are to remain visible, relevant, and impactful. One area where nurses – the largest and most trusted of health professions – have been curiously silent is the changing workforce, particularly in development of the community health worker role.

Approach: A project team of nurse leaders convened to consider the emerging role of the community health worker, nationally and in Nebraska.  Work products included an inventory of community health worker projects in Nebraska; a policy cross-walk to illuminate national and Nebraska policy developments; and a bibliography of useful resources regarding community health worker training, role expectations, and policies.  The team employed a dialectic approach to arrive at consensus recommendations regarding the development of the community health worker role.

Products/Outcome: The team developed a set of ten consensus recommendations reflecting nursing expertise and inputs into the development of the community health worker role in a transforming health system. The team also developed recommendations for the Future of Nursing – Nebraska Action Coalition.

Implications: Nurses have critical assets to offer in the continuing development of the health care workforce.  Bringing nursing expertise to health systems transformation offers critical opportunities to assure the patient-centered focus, ethics, social justice, and high-quality performance that will characterize culturally-responsive health care teams of the future.

The post The Emerging Role of the Community Health Worker: appeared first on Campaign for Action.

Approach: Business, academic, nonprofit, and nursing leaders developed a one-day training curriculum in communication, professionalism, and community engagement.  Select Texas public health nurses employed by Texas Department of State Health Services received the training. Training contents were consolidated into a toolkit for web publication.

Products/Outcome: Pre- and post-session surveys were conducted, showing slight improvement in both identifying and active seeking of new collaborations post training, but not in confidence engaging as leaders in community partnerships. A toolkit, including the curriculum agenda, training slides, course objectives, and additional resources, will be published online at the Texas Nurses Association website.

Implications: Nurses possess a unique potential for influence, and when trained for influential engagement, see their potential more broadly and want to engage more fully.  More training is needed to enhance nurses’ confidence engaging as leaders.  This and other types of shared leadership curricula may encourage practicing nurses to engage and influence.

The post Community Health Advocacy Training for Nurses – Texas, 2016 appeared first on Campaign for Action.

Problem Statement: The Washington Nursing Action Coalition (WNAC) is committed to engaging nurses, the largest segment of the healthcare workforce in the state, as leaders in health care reform.

Approach: WNAC surveyed all Washington nurses. As evident by survey results, nurses are interested in learning more about health care reform strategies in our state and the Robert Wood Johnson Culture of Health framework, which emphasizes the role of social determinants and environmental influences on the health of Washingtonians.  This presentation will highlight the methods employed by WNAC to engage nurses to apply a Culture of Health framework in their work and participate in Healthier Washington (the state plan to address health care reform), through a variety of nurse engagement strategies.

Products/Outcome: These include a resources Webpage and toolkit, conference presentations, and a short film highlighting the work of nurses and inter-professional teams addressing the social and environmental determinants.

Implications: Nurses possess a unique skill set and opportunities to lead reforms in public health and health care so that social determinants and environmental influences on health receive attention and action. The survey developed by Washington to gauge nurse interest and the engagement methods created can be adapted and replicated by nurse leaders in other states and communities. All nurses should incorporate social justice concepts in working with vulnerable populations by addressing the social and environmental determinants of health.

The post Engaging Washington State Nurses to Achieve Healthier Populations appeared first on Campaign for Action.

Approach:  Educational materials were compiled or developed to provide to nurses on social determinants and a culture of health.  Presentations were made to nursing and inter-professional groups throughout Mississippi. Nurses participated in development of the State Health Improvement Plan.

Products/Outcome: Resource list of social determinants and culture of health information, conference and event presentations, PowerPoint for presentations, website for information and sharing. Increased knowledge of participants about social determinants and building a culture of health.

Implications: Education on the social determinants of health should be a core component of nurses’ and all health professionals’ lifelong learning in order for them to have the competence, skill, and passion to take action and lead change on creating a culture of health in Mississippi communities.

The post Nurses: Building a Culture of Health in Mississippi Communities – 2016 appeared first on Campaign for Action.

Problem Statement: As of 2015, Alabama is ranked 46^th for both overall health and diabetes. According to the Centers for Disease Control and Prevention, diabetes is one of the nation’s leading causes of death. Alabama is tied for third with West Virginia at 11.1 percentage of adults who have been told by their health care provider they have diabetes. Evidence supports the value, effectiveness, and cost-effectiveness of Diabetes Self Management Education/Training (DSME/T) programs. Patients who received DSME/T in a group setting improved their diabetes knowledge and reduced their need for diabetes medication. According to the 2010 Alabama Health Disparities Status Report, Alabama’s ranking in prevalence of diabetes translates to more than one adult in ten diagnosed with diabetes; In 2015, Escambia County Alabama health ranking was 50^th out of 67 counties.

Approach: Based on the profile of Alabama and the impact of diabetes among its populations, a multi-collaborative approach was used to implement a diabetes education program using telehealth in Escambia County. Using Alabama’s new telehealth technology, we piloted a six-session DSME/T group, led by a healthcare provider in a different county connected to diabetes patients in Escambia County. Social and other media-disseminated diabetes education and prevention messages were used. Diabetes self-efficacy management was measured pre- and post-intervention using Stanford’s scoring tool and the DDS17. Results will be presented.

Products/Outcome: The project implemented diabetes education sessions between the healthcare provider in one county and the individual with diabetes in a remote county; an evidence-based diabetes education program using telehealth was implemented; patient diabetes knowledge and management self-efficacy increased; and multimedia were used to disseminate diabetes education and prevention messages.

Implications: Use of telehealth technology will reach and empower individuals living with diabetes in rural Alabama: giving them tools to make informed decisions for self-care; engaging them in effective diabetes self-management; and implementing self-care behaviors to experience optimal physical and psychological well-being

The post Telehealth Education for Patients Living with Diabetes in Rural Alabama appeared first on Campaign for Action.

Approach: Build a Harm Reduction Program with syringe access, including linkage between community partners and stakeholders, to decrease the effects of the opioid epidemic in our community. Facilitate harm reduction training for 15 West Virginia counties with the National Harm Reduction Coalition and NYC Department of Health and Mental Hygiene. Engaging community partners and stakeholders, and providing specialized training, leads to securing the funding and supplies to initiate a successful Harm Reduction Program.

Products/Outcome: On April 12, 2017, the Berkeley County Health Department opened a comprehensive Harm Reduction Program with syringe access. The program includes: safer injection practice education and supplies, Narcan training and supply, family planning services, STI, HIV, and hepatitis testing, peer coaches on site, and health care referral. The forming of a Regional Harm Reduction Coalition is in process to share resources and leverage funding sources.

Implications: Nurses emerge as community leaders to develop programs and connect community partners, which reduces stigma, builds trust, and actively works to reduce the effects the opioid epidemic causes in the community. Formation of Harm Reduction Coalitions strengthen rural networks and create partnerships that work towards the development of a statewide coalition.

The post Rural West Virginia Communities in Crisis-An Opioid Epidemic appeared first on Campaign for Action.

Problem Statement: The Triple Aim of Health Care focuses on improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Nurses, regardless of where they practice, will play key roles in achieving the population health aim.  What is needed to develop the skills that broaden the nurse’s vision into the community?  How do we engage nurses in providing services to clients by seeing the bigger picture of how their work at the “bedside” extends into the community?

Approach: This presentation describes creating an academic-practice partnership using a community-based rotation for all nursing students. We engaged a community steering committee of state and local public health, civic, academic, and clinical nurse leaders to develop and pilot an intensive curriculum through a local hospital’s summer nurse internship program. Working in a hospital clinical area with an assigned nurse mentor, students engaged in a variety of population focused activities using community and civic engagement strategies.

Products/Outcome: Community-based curriculum tied to clinical areas and populations seen in the hospital. Pre- and post-internship data will be presented. Students improved knowledge, skills, attitudes and behaviors. Student and mentor feedback provides lessons learned for improving a community-based clinical rotation that builds a culture of health.

Implications: Academic-practice partnerships engaging nursing students in community-linked clinical rotations will help prepare future nurse leaders to foster a culture of health. Preliminary data shows an education cycle of content, practice and reflection with a focus on creating a sense of community and citizen agencies, develops more awareness around population health management and building a culture of health, regardless of the area of practice.

The post Creating Nurse Leaders in Minnesota – Stearns County, 2017 appeared first on Campaign for Action.