competency assessment for population-focused public health practice susan j. zahner, drph, rn...
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Competency Assessment for Population-focused Public Health Practice
Susan J. Zahner, DrPH, RNJeffrey B. Henriques, PhDPaul M. Schwartz, MS, RN
Public Health Systems ResearchWashington, DC
June 7, 2008
Funded by US DHHS/PHS/HRSA, Division of Nursing # D11HP07731-01
Background
Statutes emphasize core functions and essential services
Changes in practice require new knowledge, skills and attitudes
Core competencies for public health professionals published/adapted
No standard competency assessment method
No prior competency assessment of PHN in Wisconsin
Linking Education and Practice for Excellence in Public Health Nursing
Statewide academic-practice partnership
Improve competency for population-focused PHN practice• Improved education for students• Improved orientation • Continuing education
Baseline assessment
Funded by US DHHS/PHS/HRSA, Division of Nursing # D11HP07731-01
Study methods
• UW-Madison IRB approval• Self-reported competency assessment
instrument (Issel, Baldwin, Lyons, & Madamala, 2006)
• ACHNE/Essential Services (2000)• Reliability/validity• Length
• Web-delivered (Websurvey@UW)• Cross-sectional baseline survey
Competency assessment instrument
Stem: “How competent do you feel with your knowledge or skills in each of the following areas?”
Response:1 = I need to be taught
about this2 = I do or can do this
with help3 = I do or can do this4 = I do this with ease5 = I do this and teach
it to others
Issel, Baldwin, Lyons, & Madamala, 2006
•9 domains•65 items
Competency assessment instrument domains (item #)
• Monitoring community health status (13 items)• Informing, educating, and empowering
populations at risk (4 items)• Mobilizing community partnerships (13 items)• Policy and planning skills (6 items)• Enforcement of laws and regulations (4 items)• Linking people to services (4 items)• Ensuring a competent workforce (12 items)• Evaluating health services (9 items)• Researching innovative solutions (6 items)
Issel, Baldwin, Lyons, & Madamala, 2006
Survey administration
• Wisconsin Health Alert Network • PHN Group email list• Removed state-level PHN addresses• N=471
• Email invitation to participate• Reminder emails at 2 and 3 weeks• April-September 2007
Participant demographics
Mean age
40.0 45.0 50.0 55.0Years
ManagersFull-time staffPart-time staff
0.0 10.0 20.0 30.0 Years
Years in public health
Managers
Full-time staff
Part-time staff
• Response rate = 63.5% (299/471)
• Female (97.8%)• White, non-Hispanic (97%)• Part-time staff (n=76)• Full-time staff (n=153)• Managers (n=42)
0%10%20%30%40%50%60%70%80%90%
100%
Part-time staff
Full-time staff
Managers
Highest degree earned
Graduate degree
Baccalaureate degree
Scale reliability
0.8 0.85 0.9 0.95 1
Monitor
Inform
Partner
Policy
Enforce
Link
Workforce
Evaluate
Research
Cronbach's Alpha
6
9
12
4
4
6
13
4
13
Mean responses by domain
1 2 3 4 5
Evaluating
Planning
Monitoring
Researching
Enforcing
Ensuring
Mobilizing
Informing
Linking
n= 296-299
2.78 (0.72)
2.70 (0.89)
2.47 (0.72)
2.44 (0.76)
2.31 (0.78)
2.24 (0.77)
2.78 (0.73)
2.83 (0.83)
3.59 (0.78)
Mean responses by domain and type of respondent
1 2 3 4 5
Evaluating
Planning
Monitoring
Researching
Enforcing
Ensuring
Mobilizing
Informing
Linking
Part-time staffFull-time staffManagers
^
Significance at alpha <.05 via one-tailed Tukey B post-hoc comparison:* = Managers/full-time ^ = Full-time/part-time
* ^
*
* ^
* ^
* ^
*
* ^
Limitations-sample
Group email list incomplete and voluntary
Under-representation of PHN by region of state
Limited generalizability
Limitations-instrument
Self-assessed perceptions versus observed competency
Response category “5” may not reflect the same concept as “1 – 4” responses
“doing with help”
Discussion
WI PHN workforce is:
• Well educated • Experienced• Aging
Discussion
Competency low in most domainsHigher perceived competency in
traditional areas of practiceHigher perceived competency in
managers compared to staff Higher competency in full-time
compared to part-time staff
Discussion
Competency assessment instrument: ReliableLengthCompare with other competency
assessment toolsUse by other public health
professionals
Conclusion
Change in practice for staff PHN toward more systems-level activity based on essential services will require additional training and support to achieve perception of competency
Next steps
• LEAP Project activities• Academia/practice regional learning
collaboratives• Orientation program• Continuing education
• Follow-up survey• Comparison with Illinois
References
Issel, L. M., Baldwin, K. A., Lyons, R. L., & Madamala, K. (2006). Self-reported competency of public health nurses and faculty in Illinois. Public Health Nursing, 23(2), 168-177.
Public Health Functions Steering Committee. (1994). The public health workforce: An agenda for the 21st century. Full report of the Public Health Functions Project. Washington, DC: U.S. Department of Health and Human Services, Public Health Service.
Quad Council of Public Health Nursing Organizations. (2004). Public health nursing competencies. Public Health Nursing., 21(5), 443-452.
Wisconsin Department of Health & Family Services. (2005). Public Health Profiles for Wisconsin. Retrieved October 22, 2007, from http://dhfs.wisconsin.gov/localdata/pubhlthprofiles.htm
Questions?
Contact: Susan Zahner, DrPH, RNAssociate ProfessorUW-Madison H6/246 CSC600 Highland AvenueMadison, WI [email protected]