Introduction

Up to this point in your nursing education, you have probably been immersed in learning how to provide nursing care to individuals and families with health concerns in institutional settings such as acute care and long-term care, and possibly in home care. This is what most of you envision as nursing and what you are passionate about. Now we are asking you to spread your wings and think about the community as your client and to use the word client instead of patient. You might be thinking, “This is not what I was planning to do in my nursing career—why am I here?” or “How can I provide nursing care to an entire community?” As you read this book, you will learn the answers to these questions. You will gain both knowledge and entry-level competencies in providing nursing care for an entire community, an at-risk population group in the community, or at-risk individuals and families in their homes or other community settings.

In today's world, baccalaureate-prepared nurses are expected to be able to manage care for populations, whether in an institutional setting or a community setting. This book will help you learn how to do this in community settings. You are going to learn about and develop skills in entry-level competencies in population-based public health nursing practice. Whether you practice in the community during your nursing career is for you to decide. However, what you learn from reading this book and completing learning activities in your public health/community health nursing clinical will provide you with knowledge about the vast array of resources available in your community that provide support for the patients you see in the emergency department or clinic or discharge from the hospital or nursing home. It is a journey into the unknown, with many challenges and benefits.

Developing competencies (skills, abilities, knowledge) that will help you become a great public health nurse takes more than mere access to or internalization of information and experiences from other people. The tools and resources presented in this manual are important; however, it is the individual—the hands, heart, and mind—who must use the tools to care and positively influence. Lillian Wald used the tools that were available to her, and when something wasn't readily available, she fought to gain access. She was driven by something deep and profound. She was grounded in the lived experiences of those she was working to serve. She acted with purpose that might have begun with caring but was fueled by the relationships she established with the sick, the impoverished, and the needy.

Nursing, especially public health nursing, can be overwhelming. The needs of individuals, families, and communities can appear insurmountable. The idea for this book originated from a shared recognition by public health nursing faculty, agency staff, and preceptors that public health nursing courses and clinical experiences are difficult for students and faculty alike. It has been well established that clinical faculty struggle with finding enough enriching experiences for students. Often, one student is placed in a school-based experience, another student is placed with a local public health agency, and yet another might be placed in a correctional setting. On the one hand, this diversity in settings and opportunities facilitates chances for students to learn from one another as they share and reflect. On the other hand, this diversity also challenges faculty to ensure that all students are learning about and growing in all the core competencies. It can also be confusing for students who have difficulty adapting clinical learning expectations to diverse settings and who might not have a nursing instructor or public health nursing preceptor with them during their clinical experiences.

The Henry Street Consortium (HSC), a group of public health nursing faculty from diverse schools of nursing and public health nurses employed in health departments, schools, and nonprofit community agencies, has been meeting regularly since 2001 to support rich, positive learning experiences for public health nursing students. The HSC developed a set of entry-level public health nursing competencies that all participants agreed to use in developing curriculum and clinical learning experiences. These HSC competencies have been informed by key public health nursing standards and guidelines, including the Quad Council core competencies (Quad Council of Public Health Nursing Organizations, 2011), the scope and standards of public health nursing (American Nurses Association, 2013; American Public Health Association, Public Health Nursing Section, 2013), and the core functions and essential services of public health (Essential Public Health Services Work Group of the Core Public Health Functions Steering Committee Membership, 1994). Companion documents have included clinical guidelines and a menu of potential learning activities based on the competencies and recognized public health nursing interventions (Minnesota Department of Health, Division of Community Health Services, Public Health Nursing Section, 2001). What had been missing, however, was a manual or guide for students and faculty to develop the skills necessary for effective entry-level public health nursing practice. We wanted to create a manual that would speak to students in an understandable, meaningful way and that would also address student concerns about practicing nursing in the complex and often disorganized community environment. We needed to prepare future public health nurses for population-based practice. We hoped to motivate students to excel in their public health nursing clinical experiences and to engage in activities that facilitate learning and, in direct care, the health promotion of diverse individuals, families, communities, and populations. We sought to encourage students to think, think, think—to use their minds to grapple with moral and ethical dilemmas and complex health needs, disparities, and inequities.

This third edition is guided by an updated set of the HSC entry-level, population-based public health nursing competencies, which include a new environmental health competency (HSC, 2017). The third edition retains the strengths of the original manual, including chapter narratives, case studies, evidence-based examples of the competencies in action, and numerous suggestions for reflection, application, and hands-on learning in your own clinical setting. Evidence examples have been updated with recent publications that demonstrate the growth of public health nursing evidence in the US and globally. Theory application examples, a new feature, are found in most chapters. We have given attention to strengthening the global relevance of the manual, with inclusion of examples of the United Nations Sustainable Development Goals. Some chapters have undergone significant revisions to fit the needs of the student learner and the practicing nurse. Some interactive and online content was purposely moved from the manual to the Instructor's Guide to facilitate use of the materials.

For the Student Nurse:

• You have chosen a career as a nurse, and some of you might become public health nurses. This clinical manual has been developed to serve as a tool you can use as you develop competencies and experience what it means to be a public health nurse.

• The knowledge and skills you acquire in your public health nursing course will enhance your effectiveness as a nurse, regardless of your employment setting. This manual helps you identify the public health principles that guide care for individuals, families, communities, populations, and systems. You will recognize and gain appreciation for public health's promotion of health and well-being and the prevention of disease and illness. You will also become aware of public health nursing's overarching commitment to addressing health disparities and inequities with strategies that improve the well-being of individuals, families, communities, and systems.

• This manual will help you learn who public health nurses are, what they do, and what makes a public health nurse effective. It leads you through the critical, or core, competencies that you need to develop.

For the New Public Health Nurse:

• This manual provides an opportunity to orient yourself to the core competencies you are expected to demonstrate as a new public health nurse.

• As part of an orientation process, this manual offers opportunities for reflection on a range of issues, challenges, and ethical dilemmas that you will likely experience in one way or another during your initial months of employment.

• Such competencies as assessment, collaboration, communication, and leadership are abilities that all new public health nurses should possess; this manual offers you the opportunity to work through some of these broader competencies using public health nursing case studies and evidence from the literature.

• Additional competencies focus on developing critical relational nursing abilities such as establishing caring relationships; demonstrating nonjudgmental acceptance of others; committing to social justice principles; and holistically undertaking the nursing process of assessment, planning, intervention development, implementation, and evaluation.

• The collaboration of practicing public health nurses and public health nursing faculty to develop this manual has contributed to the high relevance of examples, practical applications, and discussion of each competency contained therein.

For Public Health Nursing Faculty/Preceptors:

• This manual is a tool to help ensure that your students are equally exposed to core entry-level competencies and a foundational level of knowledge with respect to public health nursing. To ensure that all students receive the same foundational knowledge and skill development, regardless of clinical setting, clinical faculty might choose to assign a particular competency chapter to all students to ensure common ground. Other faculty might decide instead to assign different competencies to different students, depending on the scope of their individual clinical experience.

This manual begins with a description of foundational public health nursing concepts followed by a chapter on evidence-based public health nursing interventions. The next 12 chapters are each devoted to one core competency. The elements found in each competency chapter are outlined in the following table. A final chapter summarizes the practice of public health nursing and how this practice is consistent with expectations that baccalaureate degree nurses practice population-focused care.

In summary, this manual appreciates public health nursing tradition and encourages adoption of innovative, future-thinking practice. Lillian Wald, the founder of public health nursing, was not bound by the traditions or limitations of nursing practice in her era. She challenged, questioned, and acted. She perpetuated change and demanded that attention be given to the public health needs of children, families, and communities. She used every available asset and resource to combat poverty and disease, and when a resource didn't exist, she created one. She used evidence of the realities and challenges she saw to inform her solutions and strategies.

Today's public health nurse should do no less and has a growing base of evidence upon which to advocate for the health of those being served—evidence that ranges from a child's story to the results of a randomized controlled trial. We hope this manual promotes greater appreciation of what is expected from public health nurses and what makes them effective. We hope the manual's emphasis on evidence-based practice facilitates greater efforts by public health nurses to document effectiveness while continuing to appreciate, not minimize, the value of diverse sources of evidence. The path toward becoming an effective nurse starts with you—with your interest and determination to embrace what it means to be a nurse and, for some of you, a public health nurse. A commitment to figuring out nursing, or public health nursing, will take you on a journey that teaches, models, informs, changes, and challenges. Finally, we hope this book finds its way into your open hands, open heart, and open mind.