Public Health Nursing最新文献

Background: Despite national efforts to improve insurance coverage, access to medical care in rural U.S. communities remains limited. While insurance is a well-established enabler of healthcare utilization, its relationship to perceived access among rural adults is underexplored.

Objective: To examine whether insurance status is associated with perceived access to needed healthcare among rural adults in Connecticut, adjusting for predisposing, enabling, and need-based factors using Andersen's Behavioral Model of Health Services Use (ABMHSU).

Methods: This cross-sectional secondary analysis used the 2012-2013 Connecticut Health Care Survey data. The analytic sample included 593 unweighted cases (weighted N = 256,725). Weighted logistic regression assessed the association between insurance and perceived access, adjusting for social and health covariates.

Results: Insurance coverage was significantly associated with greater perceived access (OR = 1.38, 95% CI [1.35, 1.42], p < 0.001). Other significant predictors included gender, age, marital status, employment, and chronic conditions. The model explained 19.8% of the variance and correctly classified 76% of cases.

Conclusions: Insurance is a critical enabling factor for perceived healthcare access among rural adults, but it alone cannot ensure equitable care. Addressing both insurance gaps and the broader structural challenges, such as provider shortages, transportation barriers, and system navigation, will be essential to achieving meaningful improvements in rural healthcare access and equity.

Background: Local public health departments (LHD) geographic distribution and scope of practice result in them as a primary source of care for rural older adults. The 4M's framework (What Matters, Medications, Mentation, Mobility) was developed to assess their needs. Public health is a good fit for implementing the 4M's framework.

Purpose: Phase 1) develop and implement a quality improvement project; Phase 2) adapt the project as needed and measure implementation outcomes (percentage of older adults assessed using the 4Ms; continued agency funding after project end) METHODS: The project utilized the Institute for Healthcare Improvement Plan-Do-Study-Act (PDSA) process to design and measure change. Seven PDSA cycles were conducted over a seven-month period at LHD clinics.

Findings: 285 participants accessed a clinic with 80 participants completing the 4M's assessment tool for a 28% completion rate. Leadership identified four existing funding sources to reallocate and five potential new grants to sustain the project.

Discussion: Utilizing LHDs is an innovative approach for 4M's implementation. Obtaining data provides valuable information on what is important to older adults. Expansion of the 4M's to other programs, connecting older adults to resources, and tying results to patient-centered outcomes will be important next steps.

Objective: To describe implementation of family-centered care in maternal and child health (MCH) nursing services, before and during the COVID-19 pandemic.

Sample: Forty MCH Nurse coordinators of services providing population-wide, free, preventative health care for children aged 0-5 years and their families throughout Victoria, Australia.

Design: Cross-sectional survey conducted in early 2021. Study-developed and validated tools, adapted to context, were used to explore family-centered care in 2019 and during pandemic disruptions in 2020. Descriptive analysis compared service structures, local adaptations, and ways of working.

Results: Participants reported shifting to telehealth, shorter and fewer face-to-face consultations, reduced flexibility, and disruptions to parent groups and other community strengthening activities. Family-centered care scores were lower during the pandemic when services needed to prioritize most vulnerable children and families.

Conclusion: While family-centered care is evident throughout MCH policy and practice, there is scope for improvement. Key learnings, including new technologies and ways of working, are likely to guide future policy and practice. Local variations in service provision and community needs should be considered when evaluating, and exploring options for, preventative health care of children in the future.

Objective: To evaluate associations between the Child Opportunity Index (COI), school demographics, and presence of school nurse(s) for Los Angeles (L.A.) County schools.

Design, sample, and measurements: A cross-sectional study of L.A. County schools was conducted for 2023-2024. School demographic characteristics were obtained from a publicly available database. Forty-six L.A. County district nursing offices (encompassing 813 schools) received an electronic survey about school nurse staffing. COI quintiles were assigned using school zip codes. Simple bivariate analyses examined associations between categorical variables and school nurse presence, while Kruskal-Wallis tests assessed differences across groups for continuous variables.

Results: Twenty-six school districts responded to the survey (response rate 56.5%), representing 462 included schools. Negative associations were found between the proportions of socioeconomically disadvantaged (p < 0.0001) and Hispanic (p < 0.0001) students with the presence of a full-time school nurse. Significant variations between COI levels and school nurse presence (p < 0.0001) were observed. Schools from very high COIs had the highest likelihood of possessing full-time nurses, while schools from very low COIs had the lowest likelihood.

Conclusions: The findings of this study demonstrate significant associations between COI, school demographics, and the presence of a school nurse, illustrating disparities in access to school healthcare for L.A. County students and highlighting the importance of improving equity in school nurse staffing.

Background: Water, sanitation, and hygiene (WASH) are foundational determinants of public health and community development. Globally, approximately 2.3 billion people still lack access to safe drinking water and sanitation services. These disparities are most pronounced in low- and middle-income countries such as Haiti, and regions affected by conflict, political instability, or fragile health infrastructure.

Purpose: An integrative review was conducted to evaluate the best practices in community health volunteers' training on WASH practice outcomes in underserved communities.

Method: A literature search was performed, including articles published between 2015 to 2025 in PubMed, CINAHL, and Embase. Whittemore and Knafl's method of integrative review was employed to ensure a rigorous approach for the review, and the Johns Hopkins Nursing Evidence-Based Practice appraisal tool was used for quality and grading. Nine studies were included in the review that involved CHV training interventions in underserved populations. Results were synthesized and interpreted using the COM-B behavioral change framework.

Findings: Four themes were identified across the literature, which included (1) behavioral change, (2) knowledge and capability, (3) confidence and motivation, and (4) community engagement and opportunity, to promote successful community volunteer-led WASH training programs. Knowledge improved in most studies, but behavioral change was inconsistent. Given that the COM-B model supports that only one of the domains need to change to elicit behavior change, findings in this study suggest that building knowledge/capacity, or promoting opportunity, or encouraging motivation alone can be powerful.

Discussion: Recommendations from the literature support the implementation of community volunteer-led WASH training programs to improve overall knowledge and confidence among those engaged in WASH efforts. The recommendations are applicable to the context of WASH practices in Haiti, which remains sparse, especially in rural areas. Community-engaged research plays an integral role in how communities can embrace the behavior change necessary to achieve long-term improvements in hygiene and sanitation.

Background: To enhance workforce capacity and population health, a collaborative approach is necessary to identify and establish consistent benchmarks across community/public health nursing (C/PHN) practices and public health sectors, thereby standardizing skills, knowledge, and actions to ensure a unified level of safe, quality care.

Methods: Five key competency documents were selected based on a literature review of public health competency tools and were reviewed according to primary focus, key themes and unique features, as noted by thematic highlights identifying key components.

Results: Similarities and gaps revealed misalignment among competencies, informing a recommendation for a new model. The Public Health Outcomes through Equity, Navigation, Inclusion, and Cross-Sector Collaboration (PHOENIX) was developed, offering a universal competency framework that incorporates interdisciplinary competencies as well as nursing's' uniqueness to public health.

Discussion: Public health envelops a collective representation of a broad workforce, where cross-disciplinary strategic thinking requires the leveling of competencies to create interdisciplinary unity for a broader workforce, which also acknowledges nursing's unique role identity in direct care and practice. PHOENIX is distinct in its nursing lens, yet broad enough to capture the dynamic disciplines of all public health partners.

Introduction: Tobacco use and exposure to tobacco smoke are considered to be among the main risk factors in the development of diseases in both children and adults. The role of nurses in identifying a smoker and making them aware of the consequences of smoking to help them to quit is essential. The aim of this study was to analyze the number of students and professionals exposed to tobacco smoke and to determine their opinions on the role of professionals in the prevention and cessation of smoking.

Methodology: A descriptive cross-sectional study was carried out using an anonymous self-administered questionnaire, previously validated, which was distributed to nursing students between March and June 2022 and to nursing professionals between January and March 2023.

Results: The prevalence of smoking was found to be at 14.5% among nursing students and at 19.1% among nursing professionals. A total of 41.1% of the students and 19.4% of the professionals were continuously exposed to tobacco smoke. Furthermore, professionals showed little to no agreement with statements such as "Not contributing to smoky environments" as a reason to quit smoking, "Health professionals act as social role models," and "Smokers pay close attention to the recommendations made by health professionals" with respect to students (p < 0.001, p = 0.003, p = 0.018, respectively).

Conclusions: An association was found between tobacco use and exposure to environmental tobacco smoke, showing that the creation and maintenance of smoke-free spaces is essential. In addition, smoking students and professionals were found to be less inclined to provide smoking cessation advice to their patients. They further expressed a desire for further training to equip them with the necessary skills to offer such guidance.

The Public Health Intervention Wheel is a practice model for public health nursing that encompasses three levels of practice and 17 public health interventions. We mapped three public health nurse-led workstreams against the Public Health Intervention Wheel to help us describe the scope of our nursing practice and highlight areas for further development, whilst also testing the Wheel. The Wheel was a successful tool for evaluating the components of our work and helped us identify the strength and weaknesses of our workstreams. By using our work to test the Wheel, we identified that research and evaluation could be considered as a public health intervention within future iterations of the model.

Objective: This study aimed to compare the effectiveness of reproductive health and family planning (FP) education given to women using face-to-face (F2F) training and virtual reality (VR) methods.

Design and methods: This study is a three-group, pretest-posttest, randomized, controlled experimental study. The study was conducted between September 2022 and July 2024. As a result of the power analysis to determine the sample size, the study was completed with two experimental groups, one control group, and 40 patients in each group, totaling 120 patients. "Sociodemographic Information Form," "Scale for Determining Reproductive Health Protective Attitudes of Women," and "Family Planning Attitude Scale" were used to collect the data. The data were analyzed using SPSS 27.0 software. Descriptive statistics, Chi-square, One-Way ANOVA, and repeated measures analysis of variance were used to evaluate the research data.

Results: Compared with F2F training and control groups, the VR + F2F group showed significantly greater improvements across reproductive health protective attitudes and FP attitudes at both follow-up and post-test. While F2Feducation also improved scores compared to the control group, the VR-augmented intervention resulted in the most substantial gains. The findings indicate that VR reinforcement significantly enhances the effectiveness of traditional education in improving women's attitudes toward reproductive health and FP.

Conclusion: As a result, it was determined that the training given to women using VR applications increased reproductive health and FP knowledge and attitudes compared to F2F training and the control group.

Trial registration: NCT05678829.

Objective: This research defines the effect of gardening activities applied to older people in nursing homes on psychological well-being and depression.

Design: This research was applied as randomized controlled single-blind experimental study, which was conducted between January 2022 and December 2022.

Sample: The population of this study included older person in a Nursing Home in Türkiye, and the sample consisted of 46 older people in this nursing home.

Measurements: In this study, Older Person Information Form, Standardized Mini Mental Test, Geriatric Depression Scale, Psychological Well-Being Scale, and Satisfaction Assessment Form were used.

Intervention: Gardening activity was applied to the experimental group's older people once a week for three months.

Results: In the study, the average age of the older individuals was 74.26 ± 9.65 in the experimental group and 77.04 ± 7.57 in the control group. The pre- and post-test difference values of the "PERMA Scale" of the older person were significant, with an effect size of 3.391, and a high effect level was found (p < 0.001). A significant difference between the pre-test and post-test difference median values of the "Geriatric Depression Scale" of the older person in experimental and control groups with an effect size of 2.652, a high effect level was found (p < 0.001).

Conclusions: Gardening activities applied to older people in the experimental group increased psychological well-being and decreased depression.

Trial registration: ClinicalTrials.gov identifier: NCT05256680.