Nurse’s Week
Here at the KRISP office, we were very excited for Nurse’s Week 2012. This year’s theme is Nurses: Advocating, Leading, Caring, and one partner of the KRISP project who truly embodies this description is Elaine Conley, RN, MPH and Director of Community and Family Services at Spokane Regional Health District in Washington. Elaine serves as an excellent example as she has led her health department and PHNs to advocate and care for children and families in the community who have been affected by adverse childhood trauma.
After three grant requests were denied, Elaine regrouped and worked with her team and Washington State University to strategize ways to implement change for affected families in the communities. Elaine reassigned two RNs to go through specialized training to begin working in local schools; these RNs have assisted families in accessing services, writing policies and attending school child study meetings where teachers, parents and children are present to look at the problem through a trauma-impacted lens. A great deal of work has been accomplished and the results are remarkable. Up next, Elaine hopes to publish this intervention in collaboration with Washington State University and measure its outcomes.
We are proud to partner with Elaine as she advocates, leads and cares for her community.
Happy Nurses Week!
KRISP & QI
One of the goals of the KRISP project is that each county LHD will have a PHN quality improvement and process improvement system that contributes to improving nursing sensitive patient population outcome indicators. In working towards this goal, KRISP recently interviewed Cynthia Biedrzycki on the topic of Quality Improvement. Cynthia is a Public Health Nurse at Kane County Health Department in Illinois.
KRISP: How did you first get interested in Quality Improvement projects at the health department?
Quality Improvement (Q.I.) projects have been a part of the Health Department for several years and I have participated in several Plan Do Check Act (PDCA) projects.
However, with the participation of the health department in the PHAB accreditation process (Domain 9 focuses on Quality Improvement and Performance Management), Q.I. has become more important and visible. This domain requires plans, committee’s and formal processes for implementing Q.I. The staff was encouraged to volunteer to participate in the Quality Improvement Committee. I volunteered because I believe that these processes will make my health department a better working environment and more efficient in providing its services to the residents of Kane County.
KRISP: What is your level of involvement on Quality Improvement projects?
I am very involved in Q.I. projects. Last year, I wrote the storyboard for a High Risk Infant Follow-up PDCA, and updated it monthly as the monthly data became available. I also reported at “All Hands” meetings the progress of that PDCA project.
I am currently involved in a PDCA project for the Nurse Family Partnership/Kane Kares program (a project to increase the number of referrals from community partners and providers).
KRISP: What are some of the lessons you are learning?
Quality Improvement is a little understood process. While business is very interested in Q.I., it is still a relatively new process in public health. The Q.I. process can be uncomfortable and time consuming, and not everyone is sure that Q.I. is actually going to make the activities we engage in more productive and effective. For example, finding out that we can streamline the paperwork process of ordering needed program materials was something that was learned in a P.D.C.A. project by the health department.
KRISP: What are some of the challenges you are encountering?
As the health department has not been doing Q.I. for a very long time, the staff does not always think in terms of using the various Q.I. tools to help identify causes of problems and possible solutions. They can be more concerned about the actual work that needs to be accomplished – problem identification, strategizing about solutions is not always on everyone’s radar.
KRISP: How do you feel you personally benefited from participating in a Quality Improvement project?
I have learned a great deal about Quality Improvement and the processes involved. I have found this to be a challenge – but one that I am able to accomplish and help my co-workers learn about as well. It is also so great to be able to identify progress by monitoring the data – finding out if your chosen solution is actually working or not and being able to document it.
KRISP: What advice would you give to other public health nurses about starting a Quality Improvement cycle?
Be brave! The process may seem very cumbersome, but the rewards are worth it. I think the hardest part of a Q.I. cycle is getting started. Once you are involved with the tools and the process, the results will surprise you. They did me. I will admit to being unsure if using a PDCA process would actually change anything – but it did, and now I am an enthusiastic supporter.
KRISP, UIC and Maternal & Child Health
Several of the KRISP project’s core patient population indicators (CPPIs) are focused on the health and well-being of women and children, such as the percent of women with first prenatal care visit during the first trimester of pregnancy. Assuring access to services is a core public health function and PHNs play a vital role in making referrals and assuring that pregnant women have access to prenatal care.
In alignment with KRISP projects focused on the health and well-being of women and children is the UIC Maternal and Child Health Program. Their annual conference will take place from July 22-24, 2012 the Hyatt Lodge in Oak Brook, IL, and is sure to be a dynamic and information time centered on Leading in Challenging Times. All intergenerational, interdisciplinary academic professionals and students who are interested in the health and well-being of women, children, and families are encouraged to attend. Click here for more information.
Poster Presentation.
This week the KRISP Project blog post comes from a nurse at one of the participating local health departments. Arlene Ryndak, MPH, RN, Assistant Director for Public Health Nursing, Division of Disease Prevention at the Kane County Health Department in Aurora, Illinois, recently made a poster presentation at the ANA’s Nursing Quality Conference and the National Immunization Conference. Below is Arlene’s reflection on her that poster presentation.
“I had the pleasure of presenting a poster, entitled Improving Nurse Competency in Childhood Immunizations, at the American Nursing Association’s 6th Annual Nursing Quality Conference (January 25-27, 2012). There were two public health related posters presented out of a total of 129. There was lively participation. I presented the model we used: grouping nurses, from novice, advanced beginner and expert, together to learn the childhood immunization schedule, while at the same time using Plan, Do, Check Act to provide the structure we needed to meet our goal. Nurses were interested in how the Benner Stages of Clinical Competence could be used in various areas other than childhood immunizations. Many nurses were not familiar with the Plan, Do, Check, Act quality improvement tool; this tool drove the discussions. The ANA has asked us to present this poster at the 1st National Immunization Conference Online (which will be held March 26–28, 2012, on the Internet). After all, how can we assure children are immunized without a competent nursing workforce!”
Arlene promotes and supports population health by providing leadership to and overseeing daily operations, providing technical assistance and fiscal management, and facilitating collaboration for cross-cutting activities and initiatives. She is responsible for the tuberculosis, immunization, lead prevention, High Risk Infant Follow-up, and Nurse Family Partnership programs.
PHN Competencies.
The Quad Council of Public Health Nursing Organizations (Quad Council) updated their PHN Competencies in Summer 2011. The eight competency domains in the previous version have been retained. Each of the three tiers of competencies that reflect the job levels have corresponding specific competencies per domain. These latest competencies can be used to update job descriptions for public health nurses, as well as for public health nurse performance evaluation criteria.
You can view the changes here.
The Future of Public Health Nursing
The Robert Wood Johnson Foundation held a forum on February 7-8 on The Future of Public Health Nursing. The goal of the forum was to provide a better understanding of the current roles of public health nurses in improving health, how those roles are evolving in the changing health environment, and the implications for the future of public health nursing education and practice.
Topics discussed included:
- Critical issues facing public health nursing right now
- Forum Goals/Key Themes
- How PHNs add value to advancing population health goals
- The roles of public health nurses evolving over time
A very informative Q&A with Shirley Orr, public health consultant and Robert Wood Johnson Foundation Executive Nurse, can be viewed here.
Quality Improvement
Every once in a while new publications and recent experiences converge, as in the January 2012 issue of the Journal of Public Health Management and Practice. The articles in this issue provides some evidence-based approaches to implementing and sustaining QI projects in health departments.
Articles include a case study on using QI to promote breast feeding, and a report on lessons learned from establishing a culture of continuous quality improvement. The editorial highlights the profound difference between knowing and walking the path of QI in public health. The articles in the issue reflect the experiences of the KRISP health departments, to lesser to a greater and lesser extent, as they struggle to initiate or maintain their QI activities.
In the spirit of disseminating what we have found valuable, you can find the editorial that sets the stage for this issue, entitled “Bridging the Quality Chasm between Health Care and Public Health”, here.
