Background: Lung cancer is the single most preventable form of cancer. Tobacco smoke is the primary cause of lung cancer, but radon exposure is the second leading cause. We developed a comic book as an innovative approach to public health education based on the University of Kentucky’s BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments) FRESH (Freedom from Radon Exposure and Smoking in the Home) research study funded by the National Institute of Environmental Health Sciences. Description: A team of nurses and geologists designed a comic book, geared toward middle school aged youth and older, to communicate radon risk and remediation as well as tobacco smoke exposure as a way to prevent lung cancer. We used this creative format to disseminate information that highlights the synergistic risks of radon and tobacco smoke and promotes radon testing and mitigation, while also emphasizing the importance of geology in understanding radon origin and transportation. Main characters convey the dangers of radon in a story of good versus evil and introduces readers to actions they can take to reduce home radon exposure. Results: We will share the creative process to develop and design the comic book and present preliminary data that evaluates synergistic risk perception, interest in radon testing and mitigation, dissemination, and environmental health literacy. Conclusions: Utilizing a comic book format to convey public health information provides an accessible medium to communicate radon risks with a young audience who may prompt adults to test and fix for radon.

Background/ Issue: Rural nurses who experienced a hospital closure are a hard-to-reach population with a unique perspective. The purpose is to describe lessons learned to recruit and retain rural nurses in an Internet-based study designed to investigate the impact of rural hospital closures on nurses and residents during a pandemic.

Description: Our sample included nurses who worked in a rural hospital that closed between 2014 to 2020 in one Southwestern state. Multiple strategies were used to recruit participants. Public outreach was used through professional email listservs, newspaper advertisements, and social media advertising. Personal outreach to former rural hospital employees was conducted through social media messages, phone calls, and texts. The final sample included 10 nurses from two rural hospitals that closed in the state. Five nurses reported about a hospital that closed in 2014, while five nurses reported about a hospital that closed in 2015.

Lessons Learned: Successful recruitment required modifying our study design and strategies for identifying potential participants. Personal outreach by rural hospital champions through social media was the most effective method for recruitment and retention of rural nurse research participants. We will present recruitment data to illustrate the effectiveness of each recruitment approach and discuss specific lessons regarding recruiting hard-to-reach populations during a pandemic.

Implications/recommendations: Public Health Nurse Researchers should use a direct, personal recruitment strategy through social media messages, calls, and text messages to identify rural nurse research participants who can inform how rural hospital closures impact rural communities and nurses. Other strategies will be discussed.

Background: There exists limited research examining how school nurse workload relates to student outcomes, despite extensive evidence on beneficial effects of appropriate nurse workload on patient outcomes in hospital settings. The purpose of this study was to examine associations between school nurse workload and student health and academic outcomes.

Methods: Methods entailed secondary analysis of existing data for New York City school students in grade kindergarten through twelve during 2015/2016 (N=1,080,923). Data sources included school nurse staffing data, student academic records, student Fitnessgram data, school electronic medical records, and Census poverty data. School nurse workload was defined using an existing metric that incorporates nurse-to-student ratio and number of children with diabetes, asthma, allergies, and other medical care needs. Analytic approach was multi-level multivariate regression.

Results: Results demonstrated lower school nurse workload was associated with better student outcomes for participation in chronic disease education, though not chronic absenteeism, early dismissals, health office visits, immunization compliance, academic achievement, or overweight/obesity. Associations did not meaningfully differ by race/ethnicity, school poverty level, or neighborhood poverty level.

Conclusions: Study findings suggest school nurses may influence proximal outcomes, such as participation in chronic disease education, more easily than downstream outcomes, such as absenteeism or obesity. While contrary to hypotheses, results align with the fact that school nurses deliver community-based, population health-focused care that is inherently complex, multi-level, and directly impacted by social determinants of health. Future research should explore school nurses’ perspectives on what factors influence their workload and how they can best impact student outcomes.

Statement of the problem

A local council on aging has collaboratively worked with a broad range of community agencies to plan and implement an annual health and wellness expo for older adults to promote health and connect people with community-based services. Because of COVID, it was not feasible to implement a face-to-face expo this winter.

Approach

A school of nursing, health alliance, and council on aging partnered to plan and implement interventions aimed at promoting social engagement, connectiveness and health among older adults. We developed a virtual health and wellness expo with synchronous and asynchronous components that provide opportunities to learn, have fun, and interact. Our interventions are supported by health behaviors, scientific evidence, personalized outreach, community-based promotional activities, and incentives.

Product

We implemented a virtual health and wellness expo, featuring five focus areas: vaccinations, being active, home safety, healthy eating, and preventive services. The website features presentations, content by focus area, exhibitors’ booths, and sponsors. Nursing students partnered with health experts to deliver weekly interactive presentations in March. Council on aging staff conducted outreach to community members to help them connect to virtual events. Participants received health-related “goody bags” for participating.

Implications

Attendance at expo synchronous events more than doubled compared to prior events, and website visits increased by 70 percent. Our virtual event may serve as a model for other nursing student and agency interventions that aim to promote health using virtual approaches. We expect to maintain and enhance this outreach strategy over time.

Annually, 50,000 persons visit emergency departments due to CO exposure; and approximately 430 persons in the US die from unintentional CO poisoning. Recently, the use of alternative power after natural disasters resulted in increased incidences of CO poisoning. Exposure to CO during pregnancy also poses risks to the health of the maternal-fetal dyad. The purpose of this scoping review was to examine specific maternal-fetal outcomes, treatment, and circumstances recorded from CO exposure. Using PRISMA extension for scoping reviews, a search was conducted for peer-reviewed sources in EBSCOHost and ProQuest databases (inception to October 31, 2019). Key search words included “carbon monoxide” or CO, pregnan*, fetus, embryo, fatal* or death, intoxic*, poison* exposure, and excluded pollution. The initial search resulted in 294 articles. Five duplicates were removed; and the screening process resulted in 58 articles. These included 28 case reports, 23 review articles, and a remaining combination of cross-sectional, randomized, retrospective, prospective, and phenomenological studies. Data analysis and synthesis indicated a risk of adverse outcomes to the fetus after severe CO exposure of the mother. Hyperbaric oxygen in pregnancy was indicated as an effective CO poisoning treatment. The 28 case studies included 36 maternal-fetal pairs – 26 of which reported unintentional exposures; and 2 cases of occupational exposures. Maternal-fetal outcomes included 4 maternal deaths; 16 fetal deaths; and 20 live births. Seven cases of birth defects were noted. Public health measures, such as CO-detectors; and the role of nurse educators are both critical for preventing maternal-fetal mortality and protecting future generations.

Public Health Nurses (PHN) execute patient, community, population, and systems-focused interventions in their work every day. While public health content is a required component of all Bachelor of Science in Nursing (BSN) degree programs, Associate Degree in Nursing (ADN) programs do not consistently provide this content. Yet, many North Carolina (NC) ADN programs are beginning to include public health content in their curricula. Roughly 54% of recently surveyed non-BSN nurses in NC reported their ADN programs included public health-related content, and 100% reported a portion of their clinical education was in community-based settings, including health departments. 2020 NC nursing education trends reflect that current ADN nursing students outnumber BSN nursing students by almost two to one.

There is no national legislative requirement for PHNs to have a BSN degree. However, the NC Office of State Human Resources job classification policies require PHN-I applicants to hold a BSN degree or have at least one year of nursing experience. Those who do not meet these requirements begin with a 'trainee' designation at reduced pay, a policy causing barriers to PHN recruitment and further worsening the PHN workforce's ongoing decline, especially in the state’s more rural areas.

This presentation will review steps to change NC state policy for hiring PHN-I positions, including focus groups with PHN leaders, obtaining buy-in from health directors, and ultimately successfully navigating the state Office of State Human Resources procedural requirements to remove the 'trainee' designation from state hiring policies.

The purpose of this research was to assess the effectiveness of population health education on the self-reported competence of baccalaureate nursing students to assist with the "assessment of population health needs and development, delivery, and improvement of population health programs, services, and practices" (Amos, 2019, p.1). Healthcare organizations are increasingly looking for baccalaureate prepared nurses who have competence in population health to meet the goal of improving population health outcomes (Kent, 2018, p. 1). There is a need to measure the effectiveness of baccalaureate nursing education to prepare nurses to meet the growing demand for health care professionals who have the skills and knowledge in population health required by healthcare organizations and systems.

The Institutional Review Board approved this research. The research used a pre-post survey design. Nursing students were required to complete an online survey of Population Health Competencies as part of their course evaluation. Data from students who consented to allow the researchers access to their course survey data was used to answer the research question - Is there a change in self-reported population health competencies among baccalaureate nursing students after completing a course in community or population care?

The information gained from this research may improve the understanding of nursing students' educational needs related to the population health core competencies and strengthen nursing education, so new baccalaureate nursing graduates are better prepared to participate as members of interdisciplinary health teams to improve population health outcomes.

Background

The COVID-19 pandemic has underscored the importance of preparing all healthcare workers for public health emergencies. Disaster nursing leaders have called for increasing interprofessional learning opportunities through simulated activities to bolster disaster health knowledge and skills. This presentation describes an interprofessional disaster simulation activity adapted to a virtual format in response to COVID-19 campus closures.

Description

Public health and nursing faculty originally developed the Disaster Aftermath Interprofessional Simulation (DAIS) as an in-person exercise. DAIS provides interprofessional students an opportunity to learn how to collaboratively respond to public health disasters. The fully online exercise format utilizes internet-based tools that allow for real-time collaboration between small interprofessional groups, co-facilitation for large-group debriefing sessions, and the ability to meet the original in-person DAIS objectives. Student and faculty evaluations informed analysis of the DAIS.

Lessons Learned

The online DAIS format allowed students to meaningfully participate in the exercise despite the campus closures. Comparisons with evaluations of previous in-person exercises provided confirmatory evidence that the online exercise was of equal or greater benefit than the in-person format.

Implications

The online DAIS provided an innovative method for maintaining healthcare students’ ability to learn and interact with one another during campus closures. This opportunity to engage with others in a simulated disaster-response situation helped students develop a deeper understanding of their own professions’ roles during disasters and how to collaborate during an integrated response. The virtual DAIS expands opportunities for collaborative training efforts among various partners in responding to all types of public health disasters.