Abstract
A Disaster in Context: Response to Hurricane Maria in Puerto Rico and U.S. Virgin Islands
Linda Bedker, RN, MN, MPH
Centers for Medicare and Medicaid Services (CMS), Denver, CO
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
On September 20, 2017 Hurricane Maria struck Puerto Rico and the U.S. Virgin Islands as a Category 4 hurricane. The total devastation caused by Hurricane Maria caused total destruction of their electric infrastructure, major interruptions in telecommunication, significant damage to highways and roads and limited access to potable water and food.
In response to the disaster, the Center for Medicare and Medicaid Services (CMS) put a request asking for detailed information on the status of CMS certified facilities including dialysis centers and patients who have been impacted by the hurricanes. CMS formulated small team of U.S. Public Health Service (USPHS) Commissioned Corps officers to be deployed to the affected areas in conjunction with the Office of the Assistant Secretary for Preparedness and Response (ASPR). The purpose of CMS’ mission was to conduct onsite surveillance of CMS’ certified healthcare facilities.
CMS’ team consisted of USPHS Commissioned Corps Officers representing: nurses, pharmacists, and social workers. These Officers conducted onsite facility inspections to ensure operations were in accordance with CMS’ Conditions of Participation. CMS inspections examined the status of each faculty’s water, status of electrical grid/generators, biohazard waste, availability of oxygen and medicines, blood and laboratory services, food supply, staffing and assessments of the physical environment, to name a few.
The findings from CMS’ surveillance Team provided real-time feedback and actionable recommendations to ensure CMS certified facilities were operating safely. In addition, this mission highlighted the critical importance for all CMS certified facilities to have a well-established Emergency Preparedness Disaster Response Plan.
Environmental health sciences Public health or related nursing
Abstract
Teaching advocacy to the next generation of public health professionals
Nancy Rothman, MSN, EdD
Temple University, Philadelphia, PA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Using the following quote by APHA President, Joseph Telfair, DRPH, MPH, MSW: “ It is easy to be critical of actions (and) policies…we disagree with; it is far more challenging to…engage in actions that lead to meaningful and lasting change” (February/March 2018, The Nation’s Health), I began a class in Health Policy and Economics for senior nursing students. I shared a point that Telfair included in his article - the importance of achieving common ground with those who may not agree with you and understanding values, beliefs and opinions that you find difficult to support. I then flipped the class and setup six discussion groups to address if health care should be a right or a privilege in addressing Infant Mortality, HIV and AIDs, and Obesity and what can be done to address the health disparities in vulnerable populations. Each group was given a recent CDC publication addressing their topic and took 15 minutes to read about the distribution of their assigned health problem and15 minutes to discuss, listening well to those with whom they disagreed and looking for common ground. The nursing students eagerly shared where there was controversy within their group and where they found common ground. Lowering the cost of caring for those with their assigned health problem and early interventions with children were supported as common ground that perhaps legislators could use for moving toward meaningful and lasting innovative health care change. The lesson plan and the students’ evaluation of the class will be shared.
Public health or related education Public health or related nursing Public health or related public policy
Abstract
A Comparative Analysis of the Health Status of Latino Children: The Cases of Washington State and Arizona
Vanessa Nelson Hill, PhD, RN
Arizona State University, Phoenix, AZ
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
For the last quarter century, Washington State has been ranked in the top third of the United States in health status while Arizona has been consistently around the bottom third. This gap can be partly explained by data related to traditional determinants of health like education, income, insurance rates and income. Moreover, Washington State invests three times more resources in the public health sector than Arizona. Surprisingly, however, Latino children in Washington State have poorer health status than Latino children in Arizona. This dissertation explores possible explanations for this unexpected situation, using as a conceptual framework the cultural competency continuum developed by Cross.
The study consisted of analysis of health-related data from Washington State and Arizona, and interviews with state health administrators, local health departments, community-based organizations and university administrators in both states. This research makes a modest contribution to the role that cultural competence plays in the development and implementation of health policy and programs, and the potential impact of this approach on health status. The dissertation ends with recommendations for health policy-makers and program planners, particularly in states with a significant proportion of minority groups.
Diversity and culture Public health administration or related administration Public health or related nursing Public health or related public policy
Abstract
Community Health Nurses are Exemplar Science Diplomats
Daniel Oerther, PhD, PE, BCEE, D.AAS, F.AAN, F.RSPH
Missouri University of Science and Technology, Rolla, MO
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Issue: The emergence of science diplomacy offers an opportunity for leadership from community health nurses to promote evidence-based foreign policy in bilateral and multilateral formats.
Description: The three pillars of science diplomacy include: 1) science in diplomacy - where foreign policy objectives are supported by science (i.e., U.S. President’s Emergency Plan for AIDS Relief); 2) diplomacy for science - where diplomacy facilitates international scientific cooperation (i.e., One Health Initiative); and 3) science for diplomacy - where relationships among scientists ease tension (i.e., International Council of Nurses) (adapted from “New Frontiers in Science Diplomacy.”) Diplomats use emotional intelligence to navigate human relationships to achieve foreign policy objectives while scientists use analytical approaches to disseminate universal truth. This presentation adopts the view that nurses are the ‘science diplomats’ of the healthcare system - employing evidence-based practice to advocate and negotiate.
Lessons Learned: This presentation highlights community health nurses as 'exemplar' science diplomats using case studies from Diplomacy Lab projects completed for the U.S. Department of State. DipLab is a public-private partnership that enables the Department to “course-source” research and innovation by harnessing the efforts of students and faculty experts, and DipLab allows the American people to engage in and learn about foreign policy.
Implications/recommendations: The unique skills of nursing allow nurses to lead as 'exemplar' science diplomats. Nurses need to understand the roles and responsibilities of science diplomacy to take advantage of this opportunity.
Advocacy for health and health education Other professions or practice related to public health Public health administration or related administration Public health or related nursing Public health or related public policy Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Soliciting supplemental state funding through legislative advocacy: Lessons learned from charitable clinics in Texas
Davika Reid, MSN, RN1, Jody Hopkins, LCSW-ACSW2 and Alexandra Garcia, PhD, RN, APHN-BC, FAAN1
(1)The University of Texas at Austin, Austin, TX, (2)Texas Association of Charitable Clinics/The University of Texas at Austin, Austin, TX
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
background/Issue: Uninsured patients often seek non-urgent care from charitable clinics, where patients must be at or below 200% poverty level to qualify for services. Although charitable clinics are privately-funded, in Texas, they save the state and hospitals over $168 million dollars annually in diverted healthcare costs. Legislative advocacy is critical to increasing awareness among legislators to provide supplemental state funding for such clinics. Unfamiliarity with legislative processes and legalities regarding non-profit advocacy are barriers to clinics seeking state funding for services.
description: Full-day didactic and hands-on legislative advocacy training was provided for eight board members of the Texas Association of Charitable Clinics with two lobbyists from for-and non-profit sectors who discussed legislative processes and legalities for non-profit organizations seeking to perform advocacy.
lessons learned: For-profit sector lobbyists use financially-savvy strategies to frame funding requests and prioritize them on fiscally conservative legislative agendas. Hands-on role-playing on approaching and interacting with legislators and staff was deemed by attendees to be invaluable, as most board members in leadership roles were aware of legislative advocacy.
implications/recommendations: Although $1.5 million dollars was allocated in funding after clinic advocacy efforts, language designating funds for charitable clinics was absent so funds were given to the health department. To prepare for the next legislative session, attendees were willing to host area legislators. Since the training, one clinic hosted eight local and state legislative and business representatives, educating them on clinic services and patients. Legislative advocacy training is recommended to familiarize clinic leadership with methods for increased legislative advocacy.
Advocacy for health and health education Provision of health care to the public Public health administration or related administration Public health or related laws, regulations, standards, or guidelines Public health or related nursing Public health or related public policy
Abstract
Art and Science of Policy Change
Teresa Garrett, DNP RN PHNA-BC
University of Utah College of Nursing, SLC, UT
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Policy, system and environmental change are the hallmarks of promoting a culture of public health. System and environmental change efforts rely on partnerships, evidence-based decisions and measureable outcomes; the usual processes to implement a public health program. Policy change, on the other hand, can be an intimidating process to many, a mystery to some, and an exciting opportunity to the few. Entering the policy arena is a critical component to change and success can be had with patience, perseverance, and persistence.
From 2016-2018, nursing leaders, public health partners, health system advocates and education experts worked to develop a consortium, establish brand recognition, and provide evidence of nursing workforce and education issues. Consortium members worked to obtain legislative support for a $4.5M request to expand class size, increasing the number of nurses available to practice. The proportion of nurses in a population directly impacts the population health. Ensuring an adequate healthcare workforce is a public health imperative. The presentation will include considerations about current and past policy change efforts, social media strategies, and leadership tips for successful policy efforts.
lessons Learned:
• Begin with the end in mind – keep the end goal ‘front of mind' during negotiations
• Develop a coalition-of-the-willing to jump-start the process
• Social media is a critical component in engaging nurses in the policy process
• Celebrating early wins encourages and builds engagement.
implications:
Public health nurses have leadership skills, community relationships and culturally appropriate approaches to impact the policy change process.
Advocacy for health and health education Public health or related nursing Public health or related public policy
Abstract
Applying the Family Context to Explore Patterns in Big Public Health Nursing Data
Brady Alsaker, MN, RN1, Anne McKechnie, PhD, RN, IBCLC2, Chih-Lin Chi, PhD3, Sasank Maganti, MS2, Karen Pridham, PHD, FAAN4 and Karen A. Monsen, PhD, RN, FAMIA, FNAP, FAAN2
(1)University of Minnesota Health, Minneapolis, MN, (2)University of Minnesota, Minneapolis, MN, (3)University of Minnesota, (4)University of Wisconsin-Madison, Madison, WI
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Public health nurses (PHNs) are leaders in using the Omaha System to guide and document care. The Omaha System Data Collaborative is a practice-based research network that includes PHN data with individual and family identifiers. The purpose of this study is to explore big data techniques to identify pattern differences of problems, interventions, and outcomes for families compared to individuals in a home visiting program.
Methods: This descriptive, exploratory study used Omaha System data generated during family home visits with assessments documented by Problem Classification Scheme, interventions documented by Intervention Scheme, and outcomes measured using Problem Rating Scale. Standard descriptive and inferential statistics and visualization techniques were used to identify patterns.
Results: Preliminary results were based on 8,638 families (10,332 individuals) who received 843,603 interventions for 39,080 problems. Individuals had an average of 5.5 problems, whereas families had an average of 11.8 problems. Most interventions addressed problems classed as Caretaking/parenting (269,156; 32%), Growth and development (99,512; 12%), Pregnancy (93,834; 11%), and Income (77,924; 9%). Family outcomes showed moderate to large effect sizes for outcomes across problems. Visualization revealed double the number of clients with income and residence and problems. Variations in interventions by problem were observed.
Conclusions: Novel findings in applying the family context to analyzing PHN interventions and outcomes were detected. Family level analysis revealed more than double the number of problems compared to the individual level (e.g. Income).There is potential to explore how family context and interventions may be associated with the health of individuals.
Public health or related nursing Public health or related research
Abstract
Interprofessional Education (IPE) at a Refugee Health Clinic
Ruth Grubesic, DrPH, RN, PHCNS-BC1, Moshtagh Farokhi, DDS, MPH2, Browning Wayman, MD, DTM&H3 and Jenna Bednarz, BSN, RN2
(1)UT Health Nursing, San Antonio, TX, (2)UT Health San Antonio, San Antonio, TX, (3)UT Health San Antonio, San Antonio
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Students at UT Health in San Antonio can volunteer at a clinic providing interprofessional care to an adult refugee community. The clinic is held weekly at a local church located in the neighborhood where many refugees live. Basic medical, dental and nursing services are provided (health screenings, preventative services, labs, basic medications). Students are grouped by profession into interprofessional teams. Teams conducts a thorough assessment of the client and report back to the attendings using the SOAP format. Resources for follow up care are identified with assistance from the Center for Refugee Services.
Description: Student leaders (under the guidance of faculty) provide orientation and mentorship to volunteers. Ad hoc surveys are conducted to assess feedback from volunteers about their experience. Recently pre/post surveys were administered to new student volunteers to determine how interprofessional service learning impacts how they think, behave and practice because of the IPE experience at the clinic.
Lessons Learned: Most students who participate in this unique interprofessional experience have improved knowledge, skills and abilities when working with colleagues in other professional settings. Nursing students were affected the most. Understanding each other's roles and responsibilities improves communication, teamwork and collaboration in practice settings ultimately providing optimal patient care.
Implications: Patient care is enhanced when health care professionals are engaged in activities where they can learn about, from and with each other. Students who can work collaboratively in supervised practice settings gain skills in development of unified teamwork, improved communication, and respect for other health care professionals.
Other professions or practice related to public health Public health or related education Public health or related nursing
Abstract
Building partnerships to improve population health in your community
Caroline Kinsella, B.S.N. R.N.
Milton Massachusetts Town Hall, MILTON, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Narrative:
Problem: As a Public Health Nurse I was contacted by the Norfolk District Attorney’s office to start a Substance Abuse Prevention Coalition in the town of Milton Massachusetts. They were persistent and I was reluctant at first to start and build a coalition as I had never undertaken something like this before. The stigma surrounding this disease had led to decreased visibility and a sense of illusion that this is happening outside of Milton and not in our own backyard.
Approach: In the spirit of Community Health Nursing the problem is identified and a holistic approach must be undertaken to build partnerships, increase capacity and get buy in. Identifying who should come to the table is crucial and will help solidify the strong foundation needed to build a sustainable community coalition. ”
Product/Outcome: Often the people and groups that form coalitions have different backgrounds but come together because they share a collective goal. Empowering people to be a part of a coalition gives a sense of purpose to tackle a problem, and ignites a feeling that we are not alone in trying to find a solution for the betterment of our community and ourselves.
Implications: The Strategic Prevention Framework developed by SAMHSA will create a roadmap to start any new coalition in your community.
APA: CADCA. (2012). Handbook for Community Anti-Drug Coalitions. Print.
APA: Coalition. (n.d.) In Vocabulary.com, Retrieved March 19, 2017,
Assessment of individual and community needs for health education Public health or related nursing Systems thinking models (conceptual and theoretical models), applications related to public health