Community health training for Family and Community Health Nursing residents in a Multiprofessional Teaching Unit. Three years of experience. / Desarrollo de la competencia de atención comunitaria para residentes de Enfermería Familiar y Comunitaria en una Unidad Docente Multiprofesional provincial. Tres años de experiencia.

OBJECTIVE: To determine the interest of nursing residents in the training areas of Family and Community Nursing (EFyC) at the beginning of their training, to evaluate community activities in health centres and to determine satisfaction with the training received and activities carried out. METHOD: We present the experience of training in the public and community health competencies of EFyC Nursing from 2014 to 2017 in a multiprofessional teaching unit. The training was divided into 3theoretical modules. The training was completed with 2activities: the design and development of a health education programme and an asset mapping in the basic health area. A questionnaire was completed on satisfaction with the course and the activities carried out. RESULT: During this period, 27 residents received training. As part of the training process, 26 health education programmes and 17 asset mappings were conducted in accredited health centres. The areas of intervention addressed were: lifestyles, life transitions and health problems. The overall satisfaction with the course was 4.5 ±.1 out of 5. CONCLUSIONS: The results show a high degree of interest in this area, as well as high evaluation of the activities carried out and the training received. Training in community health and health education during the period of residence is essential to include these competencies in the professional role. The dedication and involvement of the multiprofessional teaching units is essential in the development of these competences, training the residents through the integration of a biopsychosocial approach, community health and teamwork in primary care.

Public health nurses' activities at a time of specialization in nursing-A national study.

OBJECTIVES: To provide a detailed, up-to-date account of the job description and practice areas of current public health nurses. DESIGN AND SAMPLE: A cross-sectional study. A sample of 824 public health nurses, 80% of public health nurses in Israel, participated in a national structured survey. MEASURES: A structured questionnaire eliciting self-reported public health nursing activities, priorities, perceived deficiencies, and job satisfaction was compiled. RESULTS: Nearly 70% of surveyed public health nurses provided individual-level interventions and less population-health-focused activities such as community needs assessments and development and implementation of community-based projects. CONCLUSIONS: Advanced training should be required in several areas of practice and the scope of public health nurses' practice should be expanded, with greater emphasis on population health.

Public School Nursing Practice in the United States.

School nursing practice has changed dramatically over the past 20 years, yet few nationally representative investigations describing the school nursing workforce have been conducted. The National School Nurse Workforce Study describes the demographic and school nursing practice patterns among self-reported public school nurses and the number and full-time equivalent (FTE) positions of all school nurses in the United States. Using a random sample stratified by public/private, region, school level, and urban/rural status from two large national data sets, we report on weighted survey responses of 1,062 public schools. Additional questions were administered to estimate the school nurse population and FTEs. Findings reported illustrate differences by strata in public school nurse demographics, practice patterns, and nursing activities and tasks. We estimate approximately 132,300 self-identified practicing public and private school nurses and 95,800 FTEs of school nurses in the United States. Research, policy, and school nursing practice implications are discussed.

Análise da tendência da mortalidade masculina no Rio de Janeiro: contribuição da enfermagem / Trend analysis of male mortality in Rio de Janeiro: contribution of nursing

Analisar a tendência de mortalidade entre homens no Município do Rio de Janeiro, por grupo de causas, entre 1996 e 2011. Métodos: Estudo descritivo de série temporal, utilizando dados de óbitos masculinos de residentes no Município do Rio de Janeiro, no período de 1996 a 2011, para grandes grupos de causas. Os dados foram analisados com os softwares Excel 2010 e Statistical Package for the Social Sciences (SPSS) versão 22.0. Resultados: A tendência da mortalidade por grandes grupos de causas entre homens no Município do Rio de Janeiro está decrescendo, com diferença entre os grupos de causas. Porém, estes homens seguem adoecidos com o passar dos anos. Conclusão: A Política Nacional de Atenção à Saúde do Homem deve estar mais sensível a esta realidade, ofertando uma atenção em saúde capaz de reconhecer mais integralmente as necessidades de saúde desse público...

Trends in geographic distribution of nursing staff in Japan from 2000 to 2010: a multilevel analysis.

The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types:public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PHN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased;the RRs per 1-year increment were 1.022 (95% CI:1.020-1.023), 1.021 (95% CI:1.019-1.022), and 1.037 (95% CI:1.037-1.038), respectively. In contrast, AN significantly decreased;the RR per 1-year increment was 0.993 (95% CI:0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.

Leveraging public health nurses for disaster risk communication in Fukushima City: a qualitative analysis of nurses' written records of parenting counseling and peer discussions.

BACKGROUND: Local public health nurses (PHNs) have been recognized as the main health service providers in communities in Japan. The Fukushima nuclear disaster in 2011 has, however, created a major challenge for them in responding to mothers' concerns. This was in part due to difficulties in assessing, understanding and communicating health risks on low-dose radiation exposure. In order to guide the development of risk communication plans, this study sought to investigate mothers' primary concerns and possible solutions perceived by a core healthcare profession like the PHNs. METHODS: A total of 150 records from parenting counseling sessions conducted between PHNs and mothers who have attended mandatory 18-month health checkups for their children at the Fukushima City Health and Welfare Center in 2010, 2011 (year of disaster) and 2012 were examined. Discussion notes of three peer discussions among PHNs organized in response to the nuclear disaster in 2012 and 2013 were also analyzed. All transcribed data were first subjected to text mining to list the words according to their frequencies and inter-relationships. The Steps Coding and Theorization method was then undertaken as a framework for qualitative analysis. RESULTS: PHNs noted mothers to have considerable needs for information on radiation risks as they impact on decisions related to relocations, concerns for child safety, and experiences with interpersonal conflicts within the family owing to differing risk perceptions. PHNs identified themselves as the information channels in the community, recommended the building of their risk communication capacities to support residents in making well-informed decisions, and advocated for self-measurement of radiation levels to increase residents' sense of control. PHNs also suggested a more standardized form of information dissemination and an expansion of community-based counseling services. CONCLUSIONS: Inadequate risk communication on radiation in the Fukushima nuclear incident has resulted in multiple repercussions for mothers in the community. Empowerment of local residents to assume more active roles in the understanding of their environment, increasing PHNs' capacity in communication, and an expansion of health services such as counseling will together better address risk communication challenges in post-disaster recovery efforts.

Caracterização do consumo de álcool de uma população adscrita à estratégia Saúde da Família / Caracterización del consumo de alcohol en una población adscrita a la estrategia Salud de la Familia / Characterization of alcohol consumption among the population ascribed to the Family Health strategy

O objetivo deste estudo foi caracterizar o consumo de álcool de uma população adscrita à Estratégia Saúde da Família (ESF) do município do Rio de Janeiro, Brasil. Métodos: Inquérito domiciliar desenvolvido com amostra de 301 indivíduos que reponderam a um formulário contendo variáveis de caracterização sociodemográfica e do consumo de álcool, além do Alcohol Use Disorders Identification Test. A análise exploratória dos dados foi feita no software SPSS versão 13.0 com distribuição de frequências simples. Resultados: A proporção de abstêmios mostrou-se alta (50,5%); no entanto, identificaram-se elevados níveis de consumo excessivo de álcool entre os bebedores (75,2%). Conclusão: Destaca-se a importância da ESF, e, também, que as políticas públicas brasileiras consideram o desenvolvimento de ações de prevenção ao consumo excessivo de álcool, por meios da disseminação de informações sobre as consequências negativas deste consumo à saúde e à qualidade de vida do indivíduo e das populações. .

Objetivo:Caracterizar el consumo de alcohol de una población adscrita a la Estrategia de Salud Familiar (ESF) en Rio de Janeiro, Brasil.Métodos:Averiguación domiciliar desarrollada con muestra de 301 individuos que respondieron a un formulario conteniendo variables sociodemográficas y del consumo de alcohol, además del Alcohol Use Disorders Identification Test. El análisis exploratorio de los datos fue hecho en el software SPSS 13.0, con distribución de frecuencia simple.Resultados:La proporción de abstemios se mostró alta (50,5%), sin embargo se identificaron elevados niveles de consumo excesivo de alcohol entrelos bebedores (75,2%).Conclusión:Se destaca la importancia de la ESF y también que las políticas públicas consideren el desarrollo de acciones de prevención al consumo excesivo de alcohol, a través de la diseminación de informaciones sobre las consecuencias negativas que este consumo ocasiona a la salud y a la cualidad de vida del individuo y de las poblaciones.

Integrating HIV care into primary care services: quantifying progress of an intervention in South Africa.

BACKGROUND: Integration of human immunodeficiency virus (HIV) care into primary care services is one strategy proposed to achieve universal access to antiretroviral treatment (ART) for HIV-positive patients in high burden countries. There is a need for controlled studies of programmes to integrate HIV care with details of the services being integrated. METHODS: A semi-quantitative questionnaire was developed in consultation with clinic staff, tested for internal consistency using Cronbach's alpha coefficients and checked for inter-observer reliability. It was used to conduct four assessments of the integration of HIV care into referring primary care clinics (mainstreaming HIV) and into the work of all nurses within ART clinics (internal integration) and the integration of pre-ART and ART care during the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) trial in South Africa. Mean total integration and four component integration scores at intervention and control clinics were compared using one way analysis of variance (ANOVA). Repeated measures ANOVA was used to analyse changes in scores during the trial. RESULTS: Cronbach's alpha coefficients for total integration, pre-ART and ART integration and mainstreaming HIV and internal integration scores showed good internal consistency. Mean total integration, mainstreaming HIV and ART integration scores increased significantly at intervention clinics by the third assessment. Mean pre-ART integration scores were almost maximal at the first assessment and showed no further change. There was no change in mean internal integration score. CONCLUSION: The questionnaire developed in this study is a valid tool with potential for monitoring integration of HIV care in other settings. The STRETCH trial interventions resulted in increased integration of HIV care, particularly ART care, by providing HIV care at referring primary care clinics, but had no effect on integrating HIV care into the work of all nurses with the ART clinic.

Conhecimento cotidiano de mulheres sobre a prevenção do câncer de colo do útero / common knowledge among women on prevention of cervical cancer / conocimiento cotidiano de mujeres sobre la prevención del cáncer de cuello del útero

O câncer de colo do útero é um problema de saúde pública devido ao elevado índice de morbimortalidade. O objetivo deste estudo foi apreender as representações sociais elaboradas por 64 mulheres da cidade de Teresina durante os meses de outubro e novembro de 2009, acerca da prevenção do câncer de colo do útero, bem como analisar como essas representações influem na realização do exame de prevenção. Trata-se de uma pesquisa qualitativa orientada pela Teoria das Representações Sociais. Para a coleta de dados foi utilizado o Teste de Associação Livre de Palavras. Os dados foram processados no software Tri-Deux Mots por meio dos estímulos: prevenção do câncer de colo uterino e exame de prevenção. A prevenção do câncer de colo uterino foi representada pelas palavras cuidar, saúde, tranquilidade, rotina, vergonha e dor. Conclui-se que a prevenção desse câncer compreende o cuidar da saúde da mulher através da realização rotineira do exame preventivo.

Cervical cancer is a public health problem because of its high mortality rate. This study aimed to understand social representations on prevention of cervical cancer expressed by 64 women in the town of Teresina during October and November 2009, as well as examine how those representations influence the course of the prevention examination. This qualitative study was guided by Social Representation Theory. Data was collected using the Word Association Test. The data were processed using the software Tri-Deux Mots by way of the following stimuli: cervical cancer prevention and preventive examination. Cervical cancer prevention was represented by the words care, health, tranquility, routine, shame and pain. It was concluded that, for women, cervical cancer prevention comprises health care by routine preventive screening.

El cáncer de cuello del útero es un problema de salud pública debido a la alta tasa de mortalidad. El objetivo de este estudio fue conocer las representaciones sociales elaboradas por 64 mujeres, de la ciudad de Teresina-PI-Brasil, durante los meses de octubre y noviembre de 2009, sobre la prevención del cáncer del cuello del útero, así como examinar como esas representaciones influyen en el examen de prevención. Esta es una investigación cualitativa guiada por la Teoría de las Representaciones Sociales. Para la recolección de datos se utilizó el Teste de Asociación Libre de Palabras. Los datos fueron procesados en el software Tri-Deux Mots por medio de los estímulos siguientes: prevención del cáncer de cuello de útero y examen de prevención. La prevención del cáncer de cuello de útero fue representada por las palabras cuidar, salud, tranquilidad, rutina, vergüenza y dolor. Se concluye que la prevención de ese cáncer comprende el cuidar de la salud de la mujer mediante la realización de exámenes preventivos de rutina.

Development of a public health nursing data infrastructure.

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.

A systematic method to document population-level nursing interventions in an electronic health system.

Many public health electronic health systems lack the specificity to distinguish between individual- and population-based levels of care provided by public health nurses. Data that describe the broad scope of the everyday practice of public health nurses are critical to providing evidence of their effectiveness in promoting community health, which may not be fully appreciated in an arena of scarce resources. This article describes a method to document population-based nursing practice by adding population-based interventions to the nursing taxonomy underlying an electronic health information system. These interventions, derived from the Intervention Wheel, were incorporated into the Omaha System taxonomy, the conceptual framework for the Automated Community Health Information System (ACHIS), which is a longstanding data system used to capture nursing practice in community nursing centers. This article includes a description of the development and testing of the system's ability to capture the practice of the district public health nurse model. This method of adapting an existing data system to capture population-based interventions could be replicated by public health administrators interested in better evaluating the processes and outcomes of public health nursing and other public health professionals.

Vítimas fatais e anos de vida perdidos por acidentes de trânsito em Minas Gerais, Brasil / Fatal traffic accidents victims and potential years of life lost in Minas Gerais, Brazil

Estudo objetivou analisar o perfil das vítimas fatais pelos acidentes de trânsito e quantificar o impacto desses óbitos através dos anos potenciais de vida perdidos (APVP), em Minas Gerais. Utilizou-se de abordagem epidemiológica por registros do Sistema de Informação de Mortalidade do Departamento de Informática do Sistema Único de Saúde. Entre 1996 e 2007, ocorreram 38.395 óbitos, média anual de 17,61 óbitos/100.000 habitantes. Foram 8.894,46 APVP/100.000 habitantes, perfazendo 43,24 APVP por óbito. Homens, entre 20 e 59 anos, foram as maiores vítimas fatais. Essa mortalidade apresentou ascendência entre os idosos. De forma geral, acidentes de trânsito resultam de desarranjos na infraestrutura urbana, comportamento arriscado de condutores e pedestres e ineficiências na regulação/fiscalização do tráfego. É complexo o seu impacto no setor saúde, principalmente pela perda de pessoas em idade produtiva. Perante os resultados apresentados, espera-se contribuir para o fomento de novas possibilidades de enfrentamento desse agravo.

Study aims to analyze the profile of fatal traffic accidents victims and quantify the impact of these deaths by the potential years of life lost (PYLL), in Minas Gerais, Brazil. We used an epidemiological approach for records of the Mortality Information from the Department of the Brazilian Unified Health. Between 1996 and 2007, there were 38.395 deaths, an annual average of 17.61 deaths per 100.000 inhabitants. There were 8894.46 PYLL per 100,000 inhabitants, performing 43.24 PYLL per death. Men, 20 to 59 years old, were the main casualties. This mortality ascended among the elderly. Generally, traffic accidents result from disorders in urban infrastructure, risky behavior of drivers and pedestrians, inefficiencies in the regulation/supervision of traffic. It is Complex, the impact on the health sector, mainly the loss of people of working age. Facing the results presented, it is expected to contribute to the development of new possibilities for confronting this disease.

Do public health nurses in Norway promote information on oral health?

BACKGROUND: (i) to describe oral health counselling in Norway to parents with infants and toddlers, ii) to assess existing collaboration and routines in oral health matters between nurses and personnel in the PDS, iii) to evaluate to what extent oral health was integrated in the basic educational curriculum of public health nurses. METHODS: This study was based on two separate surveys: the sample of Study I was 98 randomly selected child health clinics. A questionnaire covering oral health promotion counselling of parents with young children was returned by 259 nurses. Study II was a telephone survey addressing teachers of public health nurses at the eight educational institutions in Norway. RESULTS: The response rate in Study I was 45%. Nutrition (breast feeding, diet) was the health subject most often prioritized in the counselling targeting parents of young children (by 60% of the nurses). Oral health was not among the first priority counselling subjects. The subject was seldom spontaneously mentioned by parents. Seventy percent of respondents reported (agreed or totally agreed) that they managed to provide information parents needed and 72% believed that the information they gave influenced parents' health behaviours. Seven nurses (5.2%) responded that they agreed with the statement that the information they gave only slightly influenced parents' health behaviour. Lack of time was mentioned as being a problem. Approximately half of the nurses (48%) had regular contact with the PDS for the 0-3 year-old children, but only a quarter of the nurses claimed that children's teeth were routinely examined at the child clinics. Some forms of previously established contact with the PDS enhanced the likelihood of nurses' referrals. Oral health was a minor part of the educational curriculum for public health nurses; at three institutions, the subject was totally absent. CONCLUSION: Collaboration between nurses and the PDS in Norway could be improved. Oral health should have a bigger place in the basic educational curriculum.

Public health nurses tailor interventions for families at risk.

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.

Public health nursing case management for women receiving temporary assistance for needy families: a randomized controlled trial using community-based participatory research.

OBJECTIVES: We evaluated the effectiveness of a community-based participatory research-grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status. METHODS: We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait-control group. We assessed Medicaid outcomes pre- and posttraining; other outcomes were assessed at 3, 6, and 9 months. RESULTS: Medicaid knowledge and skills improved (P < .001 for both). Intervention group participants were more likely to have a new mental health visit (odds ratio [OR] = 1.92; P = .007), and this likelihood increased in higher-risk subgroups (OR = 2.03 and 2.83; P = .04 and .006, respectively). Depression and functional status improved in the intervention group over time (P = .016 for both). No differences were found in routine or preventive care, or general health. CONCLUSIONS: Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population.

Family home visiting outcomes for mothers with and without intellectual disabilities.

BACKGROUND: The purpose of this study was to evaluate outcomes of public health nurse home visiting for mothers with intellectual disabilities (ID) and a comparison group. METHODS: The study was a secondary analysis of existing de-identified family home visiting data. It used a two-group comparative, 1:3 match design. Sixty-eight clients were in the study (n = 17 for mothers with ID and n = 51 for mothers without ID). Client characteristics and problem prevalence were compared using standard descriptive and inferential statistics. Mixed model methods were used for the analysis of outcomes, accounting for baseline scores, time of services and matched cases. RESULTS: Mothers with and without ID showed statistically significant improvement following family home visiting services. For both groups, discharge scores were consistently higher than the corresponding admission scores, with a mean increase of 0.37 (range = 0.05-0.90). Mothers without ID attained higher outcomes than mothers with ID. Seven of 21 outcomes significantly improved for mothers with ID, and 10 of 21 for the comparison group. The percentage of mothers with ID attaining the benchmark of 4 ranged from 13.3% to 90.4% and for the comparison group ranged from 30% to 95.7%. Public health nurses addressed 15 environmental, psychosocial, physiological and behavioural problems for both groups. CONCLUSION: Family home visiting appears to be effective in assisting parents with ID to have improved outcomes in many domains. These results provide an opportunity for service providers, home visiting nurses and public health agencies to understand the unique needs of mothers with ID.

Elder abuse and neglect in a population offering care by a primary health care center in Izmir, Turkey.

The objective of this study is to investigate the prevalence of abuse and neglect of the elderly aged 65 years and older, living with their relative in a primary health care center area and affecting factors. A descriptive study included 331 people aged 65 years. The most frequent type of abuse was psychological abuse and the least frequent was sexual abuse. Female gender, low education levels, living with spouses and children, and perception of familial relationships as average or below average significantly increased abuse. The nurses providing primary health care should be able to identify and observe the elderly at risk of abuse and conduct programs preventing abuse.

Hepatitis C virus in primary care: survey of nurses' attitudes to caring.

AIM: This paper is a report of a study measuring attitudes of primary care nurses towards caring for people with hepatitis C. BACKGROUND: Hepatitis C is a major public health problem. Attitudes to caring for people with hepatitis C vary and can have an impact on nursing care practices. International literature has identified discriminating practices amongst healthcare professionals including nurses. There is limited research examining primary care nurses' attitudes to caring for people with hepatitis C. METHODS: A cross-sectional postal census survey of 981 nurses working in one health board region in the Republic of Ireland was conducted during the period March 2006 to June 2006. RESULTS: A response rate of 57.1% (n=560) was achieved. Exploratory factor analysis of an attitude scale identified three latent variables: 'infection control behaviour', 'caring' and 'fear'. Attitudes were generally positive towards caring for persons with hepatitis C; however, 51.7% of respondents would use additional infection control precautions if caring for someone with known hepatitis C. Younger nurses and those educated to degree level and above held significantly more positive attitudes to caring. Nurses agreed that they have a central role in managing and treating people with hepatitis C; however, many agreed that they lack the knowledge and skills to care for persons with hepatitis C. CONCLUSIONS: Negative attitudes can result in discriminatory experiences for persons with hepatitis C or at risk. Nurses require ongoing education on hepatitis C to improve knowledge, to limit concerns and ensure adherence to infection control guidelines.

Barriers and facilitators in the delivery of environmental risk reduction by public health nurses in the home setting.

OBJECTIVE: The goal of this study was to identify the factors that contributed to or detracted from the ability of public health nurses (PHNs) to deliver environmental risk reduction (ERR) in the home setting. DESIGN AND SAMPLE: Structured one-to-one interviews were conducted with 10 PHNs from 2 county health departments in the western United States that were delivering an ERR intervention in a randomized clinical trial. RESULTS: Barriers to incorporating ERR into PHN practice were: a change in the perceived mission of public health, nurses' lack of environmental health (EH) training, the absence of a strong relationship with EH, the multidimensional role of PHNs, presentation of nurse participation by management, incorporation of ERR visits into nursing schedules, and challenges engaging parents in EH. Facilitating factors included: training and support, opportunities for capacity building, belief that ERR is important, building a more visible face for PHN, and personal interest in EH and ERR. CONCLUSIONS: Adapting PHN practice to include ERR strategies is feasible, but not without challenges. With adequate training, time, and institutional support, multiple challenges can be overcome. PHNs are well positioned to improve the health of families and communities by integrating ERR into their scope of practice.