Jane Underwood

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Where Are the Students and New Graduates in Community Health?

Canadian Journal of Public Health, 2010

As I read the paper by Jane Underwood and colleagues on the National Community Health Nursing Stu... more As I read the paper by Jane Underwood and colleagues on the National Community Health Nursing Study, published in the September/October 2009 issue of the CJPH, 1 I could not help asking myself the question, "Where are the students and new graduates in community health?" The study, based on the analysis of workforce data, a survey and focus groups with urban and rural managers and frontline public health nurses, aimed to describe the status of community health nursing between 2005-2008. The study portrays an older workforce, experienced in collaborating interprofessionally to address community needs and social determinants of health. The authors revealed that only 5% of community nurses were younger than 30 years old. Due to the relatively small percentage of younger nurses who participated in the study, the challenges of new and recent graduates and required supports remain unknown. I anticipate that junior community health nurses or those new to community health will face a steep learning curve as connected, knowledgeable mentors leave the workforce. In recent years, demands for community health nurses have grown exponentially as a result of shortened length of stays in hospital, increased numbers of patients living with chronic illness requiring intervention and monitoring, and an aging population requiring supportive care. However, there have been only modest increases in numbers of community health nurses, and actual declines in visiting nurses in Ontario to exemplify the trends, as outlined by the Nursing Health Services Research Unit. To respond to this situation, Richard et al. (in a previous letter to the editor) concluded that investment in continuing education and training is required. Although most recent graduates have had the necessary exposure to educational preparation to meet the Canadian Community Health Nursing Standards of Practice, 4 Cohen and Gregory indicate that few enter the community health workforce upon graduation to apply that knowledge. Thus, I contend that it is important to uncover the viewpoints of students and novice nurses regarding community health in anticipation of the upcoming workforce demands. We need to create dialogue between community health practitioners, managers, researchers, educators, policy-makers and new graduates to understand this under-representation of novice nurses in community health in Canada and to create strategies to address the issue.

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Increasing evidence-based decisions about public health interventions

A Systematic Overview of the Effectiveness of Home Visiting as a Delivery Strategy for Public Health Nursing Interventions

The purpose of this systematic overview was to assess the evidence for the effectiveness of publi... more The purpose of this systematic overview was to assess the evidence for the effectiveness of public health nursing interventions when carried out by the strategy of home visiting. A search of published and unpublished literature resulted in retrieval of 108 articles; 77 articles were judged to be relevant. Validity criteria included method of allocation to the study groups, level of agreement to participate in the study, control for confounders, method of data collection (pretesting of data collection tools, blinding of data collectors to group allocation of study participants), quantitative measure of effect and percentage of participants available at follow-up. Using these criteria, 9 articles were judged to be strong, 5 moderate and 63 weak. There were no reported negative effects of home visiting in the 9 strong articles. Positive outcomes included improvement in children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s mental development, mental health and physical growth; reduction in mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anxiety, depression, and tobacco use; improvement in maternal employment, nutrition and other health habits; government cost saving; and reduced level of care required for the elderly.

The Delphi Approach to Strategic Planning

Nursing Management (Springhouse), 1991

The Delphi approach is an excellent strategy for definingphilosophy and goals through facilitatin... more

Primary care and population health promotion. Collaboration between family physicians and public health units in Ontario

Canadian family physician Médecin de famille canadien, 2001

F amily physicians deliver a range of services within preventive patient care. Preventive care is... more F amily physicians deliver a range of services within preventive patient care. Preventive care is provided on an individual basis, generally in an oppor tunistic manner. However, it is widely accepted that applying a population-based approach would result in more effective and measurable preventive outcomes, and the communitybased approach in primary care is central to the principles of family medicine. 1 Public health units and family physicians working together could provide a spectrum of primary health care services and health promotion interventions. This paper describes the development of a collaborative working initiative between the two groups and two new programs that have developed. The collaboration should be fur ther explored in primary care reform in Canada. Enhancing primar y care Each community in Ontario is served by a public health unit, which has a mandate to provide health protection, health promotion, and disease prevention services for all residents in their districts. 2 In 1995 the Hamilton-Wentworth Regional Public Health Department (RPHD), a teaching health unit affiliated with McMaster University in Hamilton, Ont, and the University of Guelph in Ontario, began to examine opportunities for partnering with family physicians. At the same time the Department of Family Medicine at McMaster University had been funded by the Ontario Ministr y of Health to develop a primar y health care program that, among other priorities, explored how collaborative relationships with public health could enhance primary care. Both groups believed that primary health care preventive services would benefit from collaboration. Public health and family medicine could work together at two levels: community-wide

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Response from Author

Canadian Journal of Public Health-revue Canadienne De Sante Publique, 2010

Public health nursing clientele shared with social assistance: proportions, characteristics and policy implications

Canadian journal of public health = Revue canadienne de santé publique

This study was designed to determine (1) the extent to which public health nursing visits and soc... more This study was designed to determine (1) the extent to which public health nursing visits and social services income programs serve the same population (shared clientele), (2) whether shared and unshared clientele differ in their characteristics, and (3) whether those who use both these services are high users of other health and social services. A computerized record linkage showed that 17% of individual public health nursing clients were shared with social services. Shared clientele had more social, perinatal, emotional and mental health problems. It is these characteristics, rather than the simultaneous use of both services, that were associated with more public health nursing visits, days in care, and use of all other health providers. The trend away from in-home nursing visits may create a situation of unmet need. While health and social resources are expended on persons with children with greater risk circumstances, the question remains about the efficacy and efficiency of thi...

A Systematic Overview of Adolescent Suicide Prevention Programs

The purpose of this systematic overview was to summarize evidence about the effectiveness of adol... more The purpose of this systematic overview was to summarize evidence about the effectiveness of adolescent suicide prevention curricula programs. A comprehensive search of published and unpublished literature resulted in retrieval of 11 relevant studies. The findings, of this overview indicate that there is currently insufficient evidence to support curriculum-based suicide prevention programs. The evidence suggests that there may be both beneficial and harmful effects of the programs on students. In most studies, knowledge related to suicide improved as a result of the programs. However, studies found both beneficial and harmful effects on attitudes related to suicide. One study found in increase in hopelessness and maladaptive coping for males following the intervention. The literature suggests that more broadly based comprehensive school health programs should be evaluated for their effectiveness in addressing the determinants of adolescent risk behaviour.

Population-based Health Promotion: A New Agenda for Public Health Nurses

The role of Public Health Nurses (PHNs) involves participation in the development and implementat... more The role of Public Health Nurses (PHNs) involves participation in the development and implementation of population-based health promotion activities. To support encourage and facilitate such participation, the Nursing Division of the Hamilton-Wentworth Department of Public Health Services initiated a &amp;amp;quot;New Agenda&amp;amp;quot; that would help to realize these PHN roles. The New Agenda involved a commitment by the Nursing Division to support population-based health promotion activities by PHNs through changes in Nursing Division policies and practices, and the advancement of a consensus among PHNs regarding the practice of population-based health promotion. A series of four workshops were designed and introduced to ensure that structural barriers to developing PHN roles were eliminated. PHNs stated they achieved role clarification and role acceptance through the New Agenda interventions.

A Pilot Study to Investigate Transmission of Headlice

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Health information for all by the year 2000? Enhancing community capacity through neighbourhood profiles

PsycEXTRA Dataset, 2000

Demographic Profile of Community Health Nurses in Canada

This series report is a working paper. It is in draft form and is distributed for purposes of com... more

Text Word Count 1486

Canadian

Community health nurses ’ learning needs in applied foundational theoretical frameworks (i.e., th... more

Accepting the Challenges of Paradigm Shifts in Community and Public Health Nursing

Renforcement de la capacité en soins infirmiers de santé communautaire et de santé publique: Rapport de synthèse de la National Community Health Nursing Study

by Jane Underwood and Raisa Deber

Canadian Journal of Public Health, 2009

infirmière autorisée, maîtrise en soins infirmiers 5 , Valerie J. Munroe, infirmière autorisée, M... more infirmière autorisée, maîtrise en soins infirmiers 5 , Valerie J. Munroe, infirmière autorisée, M.Sc. (soins infirmiers de santé communautaire) 8 RÉSUMÉ Objectifs : 1) Décrire l'effectif infirmier de santé communautaire au Canada; 2) Comparer, dans les compétences politiques et les secteurs de la santé communautaire, les éléments qui aident les infirmières et les infirmiers de santé communautaire à travailler de manière efficace ou qui les empêchent de le faire; 3) Définir les caractéristiques organisationnelles qui aident les membres d'un sous-secteur communautaire-infirmières et infirmiers de santé publique-à mettre en pratique la totalité de leurs compétences. Méthodes : Notre étude comprenait une analyse des bases de données de soins infirmiers de l'Institut canadien d'information sur la santé (1996-2007), une étude menée auprès de plus de 13 000 infirmières et infirmiers de santé communautaire au Canada et 23 groupes de discussion composés de décideurs en santé publique et d'infirmières et d'infirmiers de santé publique de première ligne. Résultats : En 2007, plus de 53 000 infirmières et infirmiers autorisés et infirmières et infirmiers auxiliaires autorisés travaillaient en santé communautaire au Canada, soit environ 16 p. 100 de l'ensemble de l'effectif infirmier. Les infirmières et les infirmiers de santé communautaire étaient en moyenne plus âgés que les autres de leur profession. Les infirmières et les infirmiers de santé communautaire travaillent habituellement dans les centres de santé communautaire, à domicile et dans les unités ou les services de santé publique. Pour effectuer leur travail de manière efficace, les infirmières et infirmiers de santé communautaire doivent avoir confiance en leurs compétences professionnelles, entretenir de bonnes relations en sein de leur équipe, travailler dans des milieux de travail favorables et obtenir le soutien communautaire. La plupart des infirmières et des infirmiers avaient confiance en leurs compétences et entretenaient de bonnes relations avec les autres infirmières et infirmiers ainsi que professionnels, quoique moins souvent avec les médecins. Ils avaient des opinions différentes relativement au salaire et à la sécurité d'emploi, et la plupart d'entre eux auraient aimé avoir plus de possibilités d'apprentissage, de renseignements sur les politiques et les pratiques ainsi que d'occasions de faire le bilan de leur travail. Ils désiraient que leur collectivité déploie de plus grands efforts pour s'occuper des déterminants sociaux de la santé et pour fournir des ressources de qualité. Certains facteurs doivent être réunis pour assurer la réussite des soins infirmiers de santé publique : une politique gouvernementale solide, une culture organisationnelle favorable et de bonnes pratiques de gestion. Parmi les caractéristiques organisationnelles considérées comme des mesures de soutien favorables à un travail optimal, soulignons la flexibilité du financement, de la conception des programmes et des descriptions de travail; une vision organisationnelle précise axée sur les valeurs partagées et les besoins communautaires; la planification coordonnée de la santé publique entre les compétences; une direction solide qui fait ouvertement la promotion de la santé publique, qui attache de l'importance au travail du personnel et qui investit dans l'éducation et la formation. * Les pointages moyens de l'échelle de Likert inférieurs à 2,5 étaient considérés comme une approbation. Les pointages variaient de 1 (approuve fortement) à 5 (désapprouve fortement). Les réponses ont été pondérées pour s'adapter au suréchantillonnage en Ontario, aux différences relatives aux tailles des populations et aux taux de réponse dans les provinces et les territoires.

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Surge Capacity and Casualization

Canadian Journal of Public Health, 2006

In Ontario, the unpredictable funding climate of the 1990s led health care organizations to look ... more In Ontario, the unpredictable funding climate of the 1990s led health care organizations to look for ways to reduce costs. Adopting a just-in-time staffing policy, they employed fewer full-time workers, scheduled part-time workers to work regular shifts, took on more casual staff, and became increasingly reliant on agency nurses and overtime to cover shifts. These policies resulted in higher costs and reduced surge capacity, and placed the health of nurses and patients in jeopardy. Fewer staff meant more overtime. Stress-related absenteeism increased. Some nurses reacted to casualization by working for multiple employers. During the SARS (severe acute respiratory syndrome) epidemic in Toronto, nursing resources were stretched to their limits. An exploratory investigation, based on relevant literature and interviews with 13 nurse administrators who held key positions during the epidemic, confirmed the lack of spare capacity in the health care system and indicated that community and long-term care sectors had less capacity than acute care. Low surge capacity in these sectors increased the vulnerability of the entire health care system. Capacity issues should be addressed as part of a larger human resources initiative to create a more flexible workforce. Since SARS, a number of government and organizational initiatives have been developed to increase nursing capacity. MeSH terms: Severe Acute Respiratory Syndrome; health manpower; nursing staff; personnel staffing and scheduling La traduction du résumé se trouve à la fin de l'article.

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Transferring public-health nursing research to health-system planning: assessing the relevance and accessibility of systematic reviews

The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 1999

A descriptive study was designed to gain an understanding of the research needs, perceptions of b... more A descriptive study was designed to gain an understanding of the research needs, perceptions of barriers to research utilization, and attitudes towards systematic reviews of decision-makers in public health at the level of systems planning. Public-health consultants and managers in Ontario were surveyed about barriers to research utilization and awareness of and attitudes towards systematic reviews as a method of/vehicle for research transfer. Access to 5 completed reviews was provided in summary, abstract, and full form, and on diskette, hard copy, and Internet. A follow-up survey at 3 months assessed use, relevance, application, and further dissemination of the reviews. A total of 242 people in positions of public-health policy and decision-making participated. Respondents reported a great, largely unmet, need for research evidence. They viewed systematic reviews as likely to overcome the barriers to research use related to critical appraisal, time, timeliness, availability, cost ...

Integration of service, education, and research in local official public health agencies

American journal of public health, 1998

Chambers et al discuss improved education for future public health practitioners. continuing educ... more

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Surviving social assistance: 12-month prevalence of depression in sole-support parents receiving social assistance

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 7, 1998

Although it is generally recognized that poverty and depression can coexist among single parents ... more Although it is generally recognized that poverty and depression can coexist among single parents receiving social assistance, there is insufficient research on this topic. The goals of this study therefore were to investigate the prevalence, correlates and health care expenditures associated with depression among sole-support parents receiving social assistance. Sole-support parents who had applied for social assistance in 2 regions of southwestern Ontario were included in the study. Depression was diagnosed with the 1994 University of Michigan Composite International Diagnostic Interview short forms. The 12-month prevalence rate of depressive disorder among the parents interviewed was 45.4% (345/760). A total of 247 (32.5%) had major depressive disorder alone, 19 (2.5%) had dysthymia, and 79 (10.4%) had both major depressive disorder and dysthymia ("double depression"). Those with major depressive disorder, particularly double depression, had significantly higher rates of...

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