NC Public Health Nurse Mentoring Orientation materials

1. NC Public Health NurseMentoring Orientation materials

2. Background Retention problems exist in all of nursing but are particularly problematic in public health Nurses entering governmental public health nursing positions appear to have knowledge deficiencies in areas such as: Population focus Epidemiology Health education Advocacy Case management

3. Background • Challenges exist attracting, recruiting and retaining public health nurses • Public health nursing workforce is aging • The cost of turnover in one position is @ 75% of the annual salary of that position.

4. COPE (Committee on Practice and Education) of NC Association of PHN Administrators has been looking at recruitment and retention issues affecting the specialty field of Public Health Nursing. Mentoring has been identified as an effective tool in assuring the successful transition of nurses to public health.

5. What is Mentoring? Mentoring is a deliberate pairing of a more skilled or more experienced person with a less skilled or less experienced one, with the mutually agreed goal of having the less skilled person grow and develop specific competencies. (Murray, 2001)

6. What is Mentoring? Mentoring is a personalized one-on-one approach to learning grounded in a personal and professional relationship between a mentee (the learner) and the mentor (the teacher). (Goldman & Schmalz, 2001)

7. Definition of Mentoring • A teacher and educator • “be available to help learn a new topic or area” • Support • “support person…in a nutshell” • A resource • “go to person” • A guide and leader • “coaching-building on big picture” • Experienced • “someone to show you the ropes” • Role model • “ someone you trust and respect”

8. They Are Different! • Mentoring • Precepting

9. Preceptor vs. Mentor

10. Benefits of Mentoring • To Mentor • Shares their successes and achievements with the mentee • Practices interpersonal and management skills • Expands horizons • Gains insight from mentee’s background • Reenergizes own career • Enlists an ally in promoting the organization’s well-being • Increases network of colleagues • Recognizes and increases skills in leadership & coaching • May reduce turnover and additional work

11. Benefits of Mentoring • To Mentee • Gains an active listening ear • Receives valuable direction • Learns a different perspective • Gains from mentor’s expertise • Receives critical feedback in key areas • Develops sharper focus • Learns specific skills and knowledge • Gains knowledge about the organization’s culture & unspoken rules • May reduce turnover and additional work

12. Responsibilities • Mentor • Introduces population-based nursing concepts • Ensures two-way open communication • Assists in establishing parameters of partnership • Provides as much career path information as possible • Shares information about career opportunities and resources • Shares information about own job and resources • Provides encouragement

13. Responsibilities • Mentor - cont’d • Monitors and provides sensitive feedback and guidance • Follows through on commitments • Acts as a role model • Respects confidentiality of information shared by mentee

14. Responsibilities • Mentee • Is willing to learn and grow • Accepts advice and provides mentor with feedback • Takes on new challenges • Remains available and open • Is proactive in relationship • Identifies goals • Accepts responsibility for own development • Demonstrates commitment to the relationship

15. Key Considerations Mentors • Is willing to spend a minimum of two hours/month with mentee • Is committed to attending mentor training and yearly updates of training • Exhibits characteristics such as: • Coaching • Motivating • Leadership • Listening • Advising • Proficiency in practice • Sharing • Encouraging • Willing to share knowledge & expertise • Is committed to the mentoring process • Has the ability to create a learning environment

16. Key Considerations Mentees • Is a new employee, where new is defined as a nurse who is new to working in a public health agency or a nurse who is in a new role in a public health agency • Has a working knowledge of career goals and objectives • Is willing to set aside time to meet with mentor • Is committed to participating • Is open to suggestions and feedback from the mentor

17. A Few Concepts AboutPublic Health Nursing

18. What is Public Health Nursing? Public Health Nursingis the practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences. (APHA, Public Health Nursing Section, 1996.)

19. Cornerstones of Public Health Nursing • Public Health • Population based • Grounded in social justice • Focus on greater good • Focus on health promotion and prevention • Does what others cannot or will not • Driven by the science of epidemiology • Organizes community resources • Long-term commitment to the community • Nursing • Relationship based • Grounded in an ethic of caring • Sensitivity to diversity • Holistic focus • Respect for the worth of all • Independent action Cornerstones of PH Nursing, Minnesota Department of Health , revised 2007

20. Population-based care vs. Individual Medical care: • Individual Medical Care • Goal is a healthy person • Primarily focuses on current patient • conditions, and prevention of onset of new conditions in a particular person • Primary strategies are biological (medication, surgery, for example), with information and education as a supplement • Advocates for services for specific patients, • and for exceptions or adaptations to policies • to accommodate those patients • Uses medical research to determine the most appropriate care for a particular patient • Recognizes the impact of environment on specific patients with specific conditions. This might include presence of respiratory triggers for patients with lung diseases, or availability • of appropriate food for diabetics. Population-based Care • Goal is an overall healthy population • Might involve health-improvement goals for a community or sub-set of a community that are many years (even a generation) away • Primary intervention strategies are provision of information, education, and communication. • Collaborates with other community groups to advocate for policies that will allow and encourage healthy behaviors • Uses community health data to plan strategies, based on the specific demographics, strengths, and weaknesses of a particular community • Has a broad awareness of the environment’s impact on health. This includes such things as safe food and water, sidewalks in good repair, availability of transportation, housing quality, etc.

21. Population Focus • Individuals present in clinic with communicable disease—treat individual • Identify population needs for disease • Preventing transmission • Communicating to your population • Providing treatment • Example: Ringworm

22. Vulnerable Populations Health Disparities Health Literacy

23. Definition of Vulnerable Populations • Greater risk for poor health status and/or problems with access to health care • Higher probability of illness and worse health outcomes than others. • Multiple risk factors interact to limit resiliency.

24. Vulnerability is Multidimensional • Resource limitations • Economic (poverty and link to hazardous • environments and in adequate nutrition) • Educational (ability to understand health • information and make informed choices) • Social(support system) • Health status (physical, biological, psychological) • Health risk (lifestyle, environmental)

25. Health Disparities • Differences in quality of care and health outcomes by age, gender, race, ethnicity, education, income, disability, sexual orientation or geography due to: • Patient level factors (e.g., biology, behaviors) • Provider-level factors (e.g., stereotyping) • System factors (e.g., lack of insurance) • Social and political factors

26. Connecting the Terms • Vulnerable population groups are most likely to experience health disparities in access to care, quality of care and health outcomes.

27. Health Literacy "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions". • From Healthy People 2010

28. Institute of Medicine A Prescription to End Confusion “Ninety million people in the United States, nearly half the population, have difficulty understanding and using health information”

29. How can nurses make a difference? • Identification (outreach and case finding) • Linking to health services (case manager) • Developing or revising programs to meet their needs • Educating them on how to promote health • Providing direct care • Advocating for programs and services to meet their needs

30. CULTURAL DIVERSITY: Gabriela Zabala Office of Minority Health and Health Disparities NC Department of Health and Human Services Forest Toms, PhD Training Research & Development, Inc. , Hickory, NC

31. Goal To build the foundation for culturally appropriate health services capable of serving an increasingly diverse population.

32. “Whenwe think… of Culture, we think of mainstream America; but when we think of Diversity the tendency is to think of minority groups.”

33. “American Culture” • White middle-class values • Dominant culture • Mainstream culture • European – American (Anglo)

34. ASSUMPTIONS & APPROACHES TO DIVERSITY • DIVISIVE/PANDORA’S BOX • ONLY BLACK/WHITE • NOT AN ISSUE • SHOULD TREAT EVERYONE THE SAME • RESOURCES • ALREADY DEALT WITH

35. “Why” of Diversity

36. What’s In a Name? • African American – Black, Africans, Carribeans • Hispanic/Latino– Mexican, Puerto Rican, Cuban, Salvadorian, Ecuadorian, Argentinan, Honduran, Dominican, etc • European/Anglo– White • American Indian – Native American, Alaska Native, Aleutian • Asian– Chinese, Filipino, Korean, Japanese, Vietnamese, Cambodian, Laotian, Hmong, Pacific Islander (Polynesian, Melanesian, Micronesian)

37. US Population Composition 1990 - 2050 American Indian Asian/Pacific Island Hispanic 2050 Black White American Indian Asian/Pacific Island Hispanic 2030 Black White American Indian Asian/Pacific Island Hispanic 1990 Black White Source: U.S. Census Bureau Percentage of US Population

38. “What” of Diversity

39. Dimensions of Diversity • Primary • Largely unchangeable human differences • Inborn • Influence our early socialization • Secondary • Can be changed • Differences we acquire, discard and modify throughout our lives

40. Age Ethnicity Gender Unchangeable Differences Race Physical Abilities/Qualities Sexual/Affectional Orientation TRD,Inc. All Rights Reserved Primary Dimensions of Diversity

41. Educational Background Work Experience Geographic Location Household Composition Marital Status Military Experience Religious Beliefs Income TRD,Inc. All Rights Reserved Secondary Dimensions of Diversity

42. Culture • Behavior patterns, arts, beliefs, institutions, and all other products of human work and thought • American Heritage Dictionary, 1991 • A view of the world and a means of adapting to the world • Bilingual Health Initiative Task Force, 1994 • Is reflected in, and influences beliefs and values, communication styles, health beliefs and practices

43. Culture Helps Us… Organizes Our Physical And Social Interaction Forms Our Identity Shapes Our Understanding And Perceptions

44. Culture Defines Family Roles Family Structure Attitudes And Practices Family Relationships Styles Of Communication Beliefs

45. Beliefs and Values • What we are used to thinking and doing • What we feel or know is right, good, important • Complex concepts with many dimensions • Influence all other area of life and activity • Affect how people think, feel, act • Can cause conflict if people’s • beliefs and values are not • incorporated in health • recommendations

46. Overview of BeliefsComparison of Common Values • Anglo-Americans • Mastery over nature • Personal control over the environment • Doing-activity • Time dominates • Human equality • Individualism/privacy • Youth • Self-help • Competition • Future orientation • Informality • Directness/openness/honesty • Practicality/efficiency • Materialism • Other Ethnocultural Groups • Harmony with nature • Fate • Being • Personal interaction dominates • Hierarchy/rank/status • Group welfare • Elders • Birthright inheritance • Cooperation • Past or present orientation • Formality • Indirectness/ritual/”face” • Idealism • Spiritualism

47. Culture and Healthcare Patients Healthcare Facilities

48. Health Status – Minority Groups • High risk for: • Heart disease, diabetes, cancer, homicides, infant mortality – African Americans • Stroke/diabetes, MVA, infant mortality American Indian • Diabetes, MVA, homicide - Hispanics • Diabetes - Asians/Pacific Islanders • Teen pregnancy • African Americans • American Indians • Hispanics

49. Barriers to Health Services • High rates of poverty • Unemployment • Cost of care • Lack of insurance • Location and hours of services • Lack of transportation • Lack of information • Language • Cultural differences between providers and clients

50. Visions of a Culturally Competent Healthcare System