Barriers related to COVID-19 testing intention.

OBJECTIVES: Although vaccination against the COVID-19 disease has recently become available, individuals are expressing fear and hesitancy towards receiving it. As a result, testing for COVID-19 is still considered a vital method to contain infection. For testing to be effective, barriers towards testing intention need to be investigated; and available literature on the challenges are scarce. This study aimed to investigate barriers of COVID-19 testing among a sample of Jordanian adults and predict testing intention within the context of these barriers. METHODS: A cross-sectional, descriptive, and predictive design was employed in this study among a sample of 1074 Jordanian adults. RESULTS: Three clusters of barriers predicted testing intention; perceived discrimination at work, concerns of individual's privacy, and having negative feelings towards testing. While perceived discrimination at work and privacy concerns were negatively associated with individuals' intention for testing, experiencing negative feelings towards COVID-19 testing was a positive predictor. CONCLUSION: Within the context of the study findings, public health nurses need to promote safety at the workplace, protect an individual's privacy, and eliminate negative feelings towards testing uptake through the provision of accurate and up-to-date information regarding the COVID-19 disease.

Attitudes towards social distancing in response to COVID-19.

OBJECTIVES: COVID-19 has highlighted differences in our engagement in health prevention behaviors. The Health Belief Model (HBM), personality traits (conscientiousness, extraversion, and neuroticism), and sociodemographic variables were used to evaluate social distancing during the first month of a state-mandated Stay At Home (SAH) order. DESIGN: A web-based convenience sample of 645 Ohioans was surveyed. Hierarchical linear regression and mediation analysis were used to examine predictors of social distancing attitudes and behaviors and whether health beliefs mediated the relationship between personality and social distancing. RESULTS: Most respondents agreed with and adhered to social distancing guidelines. HBM constructs were strong predictors of SAH attitudes, while personality accounted for little additional variance. Anxiety was indirectly related to overall social distancing attitudes and behavior through its relationship with health beliefs. However, violations of social distancing were best explained by situational factors (e.g., being an essential worker). CONCLUSION: The results demonstrate the power of components of the HBM to explain attitudes and behaviors regarding the SAH order beyond any contribution from personality. By examining the role of personality and health beliefs on social distancing attitudes and behaviors, this research will benefit public health nurses and others tasked with communicating and promoting preventative health behavior.

Quality of life and associated factors among Norwegian public health nurse students during the first months of the COVID-19 pandemic: A cross-sectional study.

The main objective of this study was to investigate the association between quality of life (QOL) and civil status, self-efficacy, loneliness, and physical and mental health among public health nurse (PHN) students during the COVID-19 pandemic in April 2020. PHN students were recruited from eight universities and university colleges in Norway. A range of potential predictive factors were entered into a model using a stepwise linear regression approach. In general, the PHN students reported a high level of QOL during the first month of the pandemic. The students' civil status, perceived physical health, self-efficacy and loneliness were all significantly correlated with QOL. Among these, the strongest predictive factors for QOL were found to be perceived loneliness and self-efficacy. Our results provide insight into the QOL of PHN students, which managers in the higher education sector can use to outline specific coping strategies that can help students during a pandemic.

Enumeration of Public Health Nurses in the United States: Limits of Current Standards.

Recent national initiatives in nursing and public health have emphasized the need for a robust public health nursing (PHN) workforce. In this article, we analyze the extent to which recent national enumeration surveys base their counts of this workforce on the definitions, scope, and standards for practice and practice competencies of the PHN nursing specialty. By and large, enumeration surveys continue to rely on practice setting to define the PHN workforce, which is an insufficient approach for meeting the goals of major nursing and public health initiatives. We make recommendations for the development of new standards for PHN enumeration to strengthen the broader public health infrastructure and evaluate PHN contributions to population-level outcomes. (Am J Public Health. 2022;112(S3):S292-S297. https://doi.org/10.2105/AJPH.2022.306782).

Number of public health nurses and COVID-19 incidence rate by variant type: an ecological study of 47 prefectures in Japan.

BACKGROUND: Community health activities by public health nurses (PHNs) are known to improve lifestyle habits of local residents, and may encourage the practice of infectious disease prevention behaviors during the COVID-19 pandemic. We investigated the association between prefecture-level COVID-19 incidence rate and the number of PHNs per population in Japan, by the COVID-19 variant type. METHODS: Our data were based on government surveys where prefectural-level data are accessible to the public. The outcome variable was the COVID-19 incidence rate (i.e., the cumulative number of COVID-19 cases per 100,000 population for each variant type in 47 prefectures). The explanatory variable was the number of PHNs per 100,000 population by prefecture. Covariates included socioeconomic factors, regional characteristics, healthcare resources, and health behaviors. The generalized estimating equations of the multivariable Poisson regression models were used to estimate adjusted incidence rate ratio (IRR) and 95% confidence interval (CI) for the COVID-19 cases. We performed stratified analyses by variant type (i.e., wild type, alpha variant, and delta variant). RESULTS: A total of 1,705,224 confirmed COVID-19 cases (1351.6 per 100,000 population) in Japan were reported as of September 30, 2021. The number of PHNs per 100,000 population in Japan was 41.9. Multivariable Poisson regression models showed that a lower number of PHNs per population was associated with higher IRR of COVID-19. Among all COVID-19 cases, compared to the highest quintile group of the number of PHNs per population, the adjusted IRR of the lowest quintile group was consistently significant in the models adjusting for socioeconomic factors (IRR: 3.76, 95% CI: 2.55-5.54), regional characteristics (1.73, 1.28-2.34), healthcare resources (3.88, 2.45-6.16), and health behaviors (2.17, 1.39-3.37). These significant associations were unaffected by the variant type of COVID-19. CONCLUSION: We found that the COVID-19 incidence rate was higher in prefectures with fewer PHNs per population, regardless of the COVID-19 variant type. By increasing the number of PHNs, it may be possible to contain the spread of COVID-19 in Japan and provide an effective human resource to combat emerging infectious diseases in the future.

A cross-sectional study on public health nurses' disaster competencies and influencing factors during the COVID-19 pandemic in Korea.

Public health nurses are performing various roles during the COVID-19 pandemic: counseling, surveillance, specimen collection, epidemiological investigation, education, and vaccination. This study investigated their disaster competencies in the context of emerging infectious diseases, and identified their influencing factors based on Deci and Ryan's self-determination theory. A convenience sample of 242 was selected from public health nurses working in a metropolitan city of South Korea. Data were collected using a structured questionnaire and analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation, and multiple regression analysis using the SPSS Statistics ver. 23.0. Results showed that the significant factors influencing disaster competencies included "willingness to respond to a disaster," "preventive behavior," "experience of receiving education on emerging infectious diseases response," "public health center experience," "job satisfaction," and "education." This regression model explained 33.2% of the variance in disaster competencies. "Willingness to respond to a disaster" was the strongest factor affecting disaster competencies. Based on these results, it is concluded that interventions to improve disaster competencies and psychological well-being of public health nurses are needed. Additionally, strategies such as creating a supportive work environment, deploying experienced nurses primarily on the front line, and reducing the tasks of permanent public health nurses should be implemented.

[Reflections on the Prospective Professional Competency of Taiwan Public Health Nurses].

Societal ageing, the rising prevalence of chronic diseases, and the COVID-19 pandemic have changed the global healthcare environment dramatically. These challenges have significantly burdened community medical and healthcare systems and complicated the work of public health nursing. As an important care provider on the frontlines of primary care, public health nurses (PHNs) must keep up with the current state of the medical environment and statistical data interpretation, scientific data translation, community resource sharing, and telehealth applications. These demands have greatly impacted the traditional routines and existing professional core competencies of PHNs. Discussions among 12 Taiwanese public healthcare experts and the definition of public health nursing capacity from World Health Organization were considered in this review. In addition to reflecting on social changes and the professional development of public health nursing, eight prospective recommendations were provided in this review to enhance the professional competence of PHNs and better prepare them for future changes in the health environment and primary healthcare. The suggestions provide a reference for updating the position statement of PHNs.

Confusions and responses of managerial public health nurses during the COVID-19 pandemic in Japan.

OBJECTIVE: This study aimed to elucidate the experiences of public health nurses (PHNs) in Japan during the first wave of COVID-19. DESIGN AND SAMPLE: Twelve PHNs in charge of responding to COVID-19 in X-city within Tokyo metropolis in Japan participated in this case study. MEASUREMENTS: Data were collected through self-administered questionnaires and semi-structured interviews on PHNs' experiences from January 2020 to May 2020. RESULTS: Initially, only infectious disease control division (IDCD) PHNs experienced confusion due to the rapidly increased workload. Managerial PHNs attempted to explain the need for a dispatch system for the IDCD, using available statistical data from other managerial members, within one's maximum understanding of this unprecedented situation. Without having a clear and forward-looking understanding regarding the purpose and reasons for dispatching, some dispatched PHNs had concerns and frustrations; they did not view the COVID-19 pandemic as a disaster. In the never-ending, exhausting work, PHNs managed to modify the provision of conventional services to residents. CONCLUSIONS: Despite experiencing confusion, PHNs worked to continuously provide community services, re-considering the meaning of public health nursing. Prioritizing the work and shifting tasks to other professionals at an early stage of the pandemic may prevent organizational dysfunction.

Factors influencing public health nurses' ethical sensitivity during the pandemic.

BACKGROUND: Ethical sensitivity is a prerequisite for ethical nursing practices. Efforts to improve nurses' ethical sensitivity are required to correctly recognise ethical conflicts and for sound decision-making. Because an emerging infectious disease response involves complex ethical issues, it is important to understand the factors that influence public health nurses' ethical sensitivity while caring for patients with COVID-19, an emerging infectious disease. OBJECTIVES: This study aims to identify the relationship between nursing professionalism, the organisation's ethical climate, and the ethical sensitivity of nurses who care for emerging infectious disease patients in Korean public health centres. Further, it sought to identify factors influencing ethical sensitivity and the mediating effect of the organisational ethical climate to inform guidelines and improve ethical sensitivity. RESEARCH DESIGN: This was a cross-sectional descriptive study. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected from February 3 to 8 March 2021. Participants included 167 nurses caring for patients with COVID-19 in public health centres in South Korea. ETHICAL CONSIDERATION: This study was approved by the Institutional Review Board of the Chung-Ang University and followed the principles of research ethics. RESULTS: The factors influencing ethical sensitivity were working at a COVID-19 disease direct response department, nursing professionalism, and organisation's ethical climate. The organisation's ethical climate showed a partial mediating effect on the influence of nursing professionalism on ethical sensitivity. CONCLUSION: Our findings show that nurses' ethical sensitivity can be improved by refining the organisation's ethical climate and nursing professionalism.

Implementing public health nursing training for Ireland's National Healthy Childhood Programme.

Public health nurses (PHNs) in Ireland provide preventative child health. An evidence-based National Healthy Childhood Program (NHCP) has been in development since 2016. The final program implementation, including training all PHNs coincided with the Covid-19 pandemic. OBJECTIVE: To describe implementation and evaluation of a blended training program for PHNs DESIGN: The evaluation used quantitative and qualitative methods underpinned by an implementation science framework to assess the training program. The three-phase blended training was led by a Training and Resources implementation team. Data from a national cohort of PHNs (n = 1671) who completed training were descriptively analysed. RESULTS: The majority of PHNs completed a suite of four online units (phase 1), as well as self-directed and asynchronous content in phase 2. Results of phase 2 indicated it met participant needs in terms of knowledge but outstanding needs in terms of skills remained. Phase 3 (a modified Face to Face Clinical Skills Review) was completed by 1671 PHNs over a 5-month period in 2020. Evaluation was very positive in terms of organisation and usefulness for practice. CONCLUSIONS: Despite challenges the NHCP training implementation goals were met. A well-designed blended learning training program met service delivery imperatives and PHN needs.

Emotional Labor and Burnout of Public Health Nurses during the COVID-19 Pandemic: Mediating Effects of Perceived Health Status and Perceived Organizational Support.

The purpose of this study was to identify the mediating effects of perceived health status (PHS) and perceived organizational support (POS) in the association between emotional labor and burnout in public health nurses (PHNs). The participants were 207 PHNs convenience sampled from 30 public health centers and offices in Jeju, Korea. Data regarding emotional labor, PHS, POS, and burnout were collected between February and March 2021 using a structured questionnaire. Collected data were analyzed by Pearson's correlation coefficient and multiple regression analysis. Burnout of PHNs was positively correlated with emotional labor (r = 0.64, p < 0.001) and negatively correlated with PHS (r = -0.51, p < 0.001) and POS (r = -0.51, p < 0.001). In the association between emotional labor and burnout, PHS (B = -1.36, p < 0.001) and POS (B = -0.42, p = 0.001) had a partial mediating effect. Reduction of burnout among PHNs requires not only effective management of emotional labor but also personal and organizational efforts to improve PHS and POS.

The first line of prevention: A public health nursing advocacy video.

Public health nurses (PHNs) serve as the first line of prevention in public health and safety threats such as the COVID-19 pandemic. Although PHNs provide vital services to protect communities and populations' health, a pervasive lack of knowledge exists regarding the PHN role among policymakers and the general public. Advocacy for investment in the public health nursing workforce remains a priority as staffing and financial constraints have created sizeable barriers for PHNs during the COVID-19 response. Creating an advocacy video with personal stories from PHNs emerges as a powerful and cost-effective strategy to increase the visibility of PHNs. For this project, interviews with PHNs from COVID-19 hot spots were used to create a 3-min advocacy video. PHNs featured in this video discussed the implications of rerouting resources to combat COVID-19 for the populations they serve. The authors disseminated the video through popular social media venues, public health and nursing organizations and nurse influencers to reach nursing students, faculty, and the public. Over an 8-week period, the video received 2732 views on social media with an average view duration of 2 min. This article includes strategies to maximize the impact of an advocacy video when shared with relevant stakeholders.

Work environment challenging Irish public health nurses' care quality: First postnatal visit.

OBJECTIVES: Exploring views and experiences of public health nurses of their work environment and measurement of care practices at first postnatal visits. DESIGN: An exploratory qualitative design. Data collected using four focus groups and analyzed using thematic analysis. SAMPLE: Nineteen public health nurses from four health service regions in Ireland participated. RESULTS: Two themes emerged. Theme one identified "challenges of providing a quality service." Public health nurses identified workload demands and that the working environment can detract from the ability to provide a quality service. Challenges within the home, language barriers, and lack of support from management were key issues. Theme two identified "challenges of measuring quality of public health nursing practice." While Measuring practice through quantitative outcomes such as key performance indicators were viewed as inadequate to measure the quality of care provided, positive views of using quality process indicators to measure the quality of their practice emerged. CONCLUSIONS: Key issues concern the working environment of public health nurses and challenges of providing and measuring care practices. Absence of appropriate supports and resources means public health nurses work hard to provide quality care. Public health nurses were confident they would score high on quality process measurements of their practice.

Effect of virtual reality simulation training on the response capability of public health emergency reserve nurses in China: a quasiexperimental study.

OBJECTIVE: To develop a virtual reality simulation training programme, and further verify the effect of the programme on improving the response capacity of emergency reserve nurses confronting public health emergencies. DESIGN: A prospective quasiexperimental design with a control group. PARTICIPANTS: A total of 120 nurses were recruited and randomly divided into the control group and the intervention group. INTERVENTION: Participants underwent a 3-month training. The control group received the conventional training of emergency response (eg, theoretical lectures, technical skills and psychological training), while the intervention group underwent the virtual reality simulation training in combination with skills training. The COVID-19 cases were incorporated into the intervention group training, and the psychological training was identical to both groups. At the end of the training, each group conducted emergency drills twice. Before and after the intervention, the two groups were assessed for the knowledge and technical skills regarding responses to fulminate respiratory infectious diseases, as well as the capacity of emergency care. Furthermore, their pandemic preparedness was assessed with a disaster preparedness questionnaire. RESULTS: After the intervention, the scores of the relevant knowledge, the capacity of emergency care and disaster preparedness in the intervention group significantly increased (p<0.01). The score of technical skills in the control group increased more significantly than that of the intervention group (p<0.01). No significant difference was identified in the scores of postdisaster management in two groups (p>0.05). CONCLUSION: The virtual reality simulation training in combination with technical skills training can improve the response capacity of emergency reserve nurses as compared with the conventional training. The findings of the study provide some evidence for the emergency training of reserve nurses in better response to public health emergencies and suggest this methodology is worthy of further research and popularisation.

HPV vaccine promotion: Snapshot of two health departments during the COVID-19 pandemic.

The COVID-19 pandemic has impacted routine health care services including immunization delivery. The most common sexually transmitted infection in the United States is the human papillomavirus (HPV), and its sequelae may be prevented by vaccination. Sequelae that can develop if one's immune system is not able to clear the infection include warts, precancerous lesions, and cancer. The American College of Obstetricians & Gynecologists (ACOG) reports almost everyone who is sexually active will encounter the virus at some time during their life. Most of the estimated 79 million infections occur among people who are in their late teens or early 20s. Since 2006, there has been a vaccine available to prevent HPV infections in both males and females; however, administration of this vaccine has only been about half the rate of other vaccines and vaccine hesitancy may play a role. Public health nurses are vital in providing accurate and nonjudgmental vaccine education to their clients, especially unaccompanied minors seeking care in public health department clinics. This paper will explore the recommendations for providing this vaccine as well as a snapshot of current practice in two health departments in the Southeast region of the United States during the COVID-19 pandemic.

Personal reflections on navigating the COVID-19 pandemic: From vision to reality.

Transitioning from bedside nursing to public health nursing after graduating with my Master's in Public Health was a unique experience, particularly as I navigated the COVID-19 pandemic as a new public health and nursing leader. Personal reflection pieces can provide a meaningful review of the experiences of integrating clinical nursing practice and more broad public health practice. The purpose of this paper is to offer my reflection and synthesis of the lessons learned while leading a Federally Qualified Health Center (FQHC) through the COVID-19 pandemic. Additionally, I reflect on the future of FQHCs and the critical need to advance public health as a field and empower public health nurses.

Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses.

OBJECTIVE: To report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service. DESIGN: This was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained. SETTING: This study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada. PARTICIPANTS: Of all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN). PRIMARY AND SECONDARY OUTCOME MEASURES: Uptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN. FINDINGS: 69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period. CONCLUSIONS: Nurse-led PrEP is an appropriate strategy for PrEP delivery.

Prevalence and predictors of coronaphobia among frontline hospital and public health nurses.

OBJECTIVES: To determine the prevalence as well as the predictors of coronaphobia in frontline hospital and public health nurses. DESIGN: This study used a cross-sectional research study involving 736 nurses working in COVID-19 designated hospitals and health units in Region 8, Philippines. Four structured self-report scales were used, including the Coronavirus Anxiety Scale, the Brief Resilience Scale, the Perceived Social Support Questionnaire, and the single-item measure for perceived health. RESULTS: The prevalence of coronaphobia was 54.76% (n = 402): 37.04% (n = 130) in hospital nurses and 70.91% (n = 273) in public health nurses. Additionally, nurses' gender (ß = 0.148, p < .001), marital status (ß = 0.124, p < .001), job status (ß = 0.138, p < .001), and personal resilience (ß = -0.167, p = .002) were identified as predictors of COVID-19 anxiety. A small proportion of nurses were willing (19.94%, n = 70) and fully prepared (9.40%, n = 33) to manage and care for coronavirus patients. CONCLUSION: Coronaphobia is prevalent among frontline Filipino nurses, particularly among public health nurses. Interventions to address coronaphobia among frontline nurses in the hospital and community should consider the predictors identified. By increasing personal resilience in nurses through theoretically driven intervention, coronaphobia may be alleviated.

A Century Later: Rural Public Health's Enduring Challenges and Opportunities.

The US public health community has demonstrated increasing awareness of rural health disparities in the past several years. Although current interest is high, the topic is not new, and some of the earliest public health literature includes reports on infectious disease and sanitation in rural places. Continuing through the first third of the 20th century, dozens of articles documented rural disparities in infant and maternal mortality, sanitation and water safety, health care access, and among Black, Indigenous, and People of Color communities. Current rural research reveals similar challenges, and strategies suggested for addressing rural-urban health disparities 100 years ago resonate today. This article examines rural public health literature from a century ago and its connections to contemporary rural health disparities. We describe parallels between current and historical rural public health challenges and discuss how strategies proposed in the early 20th century may inform current policy and practice. As we explore the new frontier of rural public health, it is critical to consider enduring rural challenges and how to ensure that proposed solutions translate into actual health improvements. (Am J Public Health. 2020;110:1678-1686. https://doi.org/10.2105/AJPH.2020.305868).

COVID-19: Planning and Postpandemic Partnerships.

The emergence of coronavirus disease 2019 (COVID-19) has highlighted the need for strong partnerships between educators and healthcare professionals to facilitate the reopening of schools. School nurses are uniquely positioned to bridge this gap because of their role as a healthcare professional in the educational setting. Past research identifies the effectiveness of collaborative efforts to serve students by community partners, school system personnel, and school nurses. However, partnerships have been episodic and reactive rather than ongoing and proactive. The circumstances of COVID-19 present an opportunity for school nurses to promote collaboration and planning as an ongoing practice. Recommendations for school nurses to form ongoing public health and school system partnerships, as well as with teachers, parents, and school nursing colleagues, are presented.