Entry-to-Practice Public Health Nursing Competencies For .
Entry-to-Practice Public Health NursingCompetencies for UndergraduateNursing Education
Canadian Association of Schools of Nursing 20141145 Hunt Club Road, Unit 450Ottawa, ONK1V 0Y3Suggested citation: Canadian Association of Schools of Nursing. (2014). Entry-to-Practice Public Health Nursing Competencies for Undergraduate Nursing Education. Ottawa ON: Author.
Table of contentsAcknowledgments1Purpose2Competency Framework3Background4Entry-to-Practice Public Health Nursing Competencies for Undergraduate NursingEducationDomain 1—Public Health Sciences in Nursing Practice67Domain 2—Population and Community Health Assessment and Analysis8Domain 3—Population Health Planning, Implementation, and Evaluation9Domain 4— Partnerships, Collaboration and Advocacy10Domain 5— Communication in Public Health Nursing11Glossary12References17
AcknowledgementsThe Canadian Association of Schools of Nursing (CASN) gratefully acknowledges the expertise, time,and contributions of all those who engaged in the development of the Entry-to-Practice Public HealthNursing Competencies for Undergraduate Nursing Education.CASN Public Health Task ForceRuth Schofield, RN, MSc(T) (Co-Chair)Immediate Past PresidentCommunity Health Nurses ofCanadaDonalda Wotton, RN, MN (Co-Chair)College of Nursing, Faculty ofHealth SciencesUniversity of ManitobaAndrea Chircop, RN, PhDAssistant Professor, School ofNursingDalhousie UniversityCarol Rupcich, RN, MNClinical Consultant, PerinatalMental Health Services, Child &Adolescent Addiction & MentalHealth ProgramDirector, Western SchoolsAlberta Health ServicesChair, AFMC Public HealthEducators’ NetworkAssociation of Faculties ofMedicineGloria Merrithew, RN, MNSenior Policy and Program Advisor,Public Health Practice andPopulation Health, Government ofCanadian Public HealthAssociation (NB/PEI)Jo Ann Tober, RN, PhD, CCHN(C)Past PresidentANDSOOHA Public HealthNursing ManagementLisa Ashley, RN, CCHN(C), M. Ed.Senior Nurse AdvisorCanadian Nurses AssociationMarie Dietrich Leurer, RN, PhDAssistant Professor, College ofNursingUniversity of SaskatchewanMorag Granger, RN, BSN, CCHN(C)Manager, Public Health Nursing,Population and Public HealthServicesAssociate Professor, School ofNursingRegina Qu’Appelle HealthRegionRobin Scobie, RN, MScNAssistant Teaching Professor,School of NursingUniversity of VictoriaSusan Duncan, RN, PhDAssociate Professor, NursingThompson Rivers UniversityDenise Bowen, RN, MNDenise Donovan, MDOmaima Mansi, RN, PhD (cand)CASN Board of DirectorsMcGill UniversityThis publication was produced by the CASN with funding from the Public Health Agency of Canada.1
PurposeThe Canadian Association of Schools of Nursing (CASN) Entry-to-Practice Public Health Competenciesfor Undergraduate Education are the core competencies in public health nursing that all nursingstudents should acquire over the course of their undergraduate education. Each competency isaccompanied by a set of indicators that identify the specific knowledge, skills, and attitudes thatnursing students must gain in order to develop the particular competency. The competencies andindicators provide direction for curriculum development and for educators teaching in the area ofpublic health. They are intended to build on, but not replace, other curriculum elements.2
Competency FrameworkCompetencies are complex know-acts based on combining and mobilizing internal resources(knowledge, skills, attitudes) and external resources and applying them appropriately to specifictypes of situations (Tardif, 2006). The Entry-to-Practice Public Health Competencies for UndergraduateEducation are organized under five domains:1.Public Health Sciences in Nursing Practice2.Population and Community Health Assessment and Analysis3.Population Health Planning, Implementation, and Evaluation4.Partnerships, Collaboration and Advocacy5.Communication in Public Health NursingThe indicators under each competency statement are the assessable and observable manifestations ofthe critical learnings needed to develop the competency (Tardif, 2006).The terms used in the competency and indicator statements are defined in the Glossary.3
BackgroundIn 2012, CASN began a project funded by the Public Health Agency of Canada (PHAC) titled,Mobilising the Development and Implementation of Entry-to-Practice Discipline-Specific Public HealthNursing Competencies in Undergraduate Nursing Education. One of the project goals was to supportthe integration of current and relevant public health content into baccalaureate nursing educationby creating core competencies that would detail the knowledge, skills, and attitudes new nursesneed to learn in this particular area of health care. A CASN Public Health Task Force of public healthnursing experts from across Canada was struck in order to carry this out.An environmental scan of resources regarding public health nursing in Canada was the first step inthe process. A search of peer reviewed literature was conducted using various online databases:Cumulative Index to Nursing and Allied Health Literature, PubMed, and Science Direct. The searchterms entered into the databases included “public health nursing competencies”, “community healthnursing competencies”, “public health in nursing education”, and “public health nursing”.Publications were included in this literature review if: 1) they listed specific public health orcommunity health nursing competencies and/or listed public health elements that the authors feltshould be included in nursing curriculum, and 2) if they discussed public health education ofregistered nurses. A targeted grey literature search for public health competencies was alsocompleted by visiting the websites of relevant institutions.CASN reviewed the public and community health content in the Competencies for entry-levelregistered nurse practice (College of Nurses of Ontario, 2014) defined by the provincial regulators,and the competencies used to create the current entry-to-practice exam (Canadian NursesAssociation, 2010). As the entry-to-practice exam for Canadian nurses is changing in 2015, CASN alsoreviewed the NCLEX-RN test plan (National Council of State Boards of Nursing, 2013). The PublicHealth Agency of Canada (PHAC) has outlined public health competencies that should be possessedby all individuals working in public health (2009). Additionally, public health nursing competencieshave been identified by nursing organizations such as the Community Health Nurses of Canada(CHNC) and the Canadian Nurses Association (CNA) certification program (CHNC, 2009; CNA, 2011),but they are not levelled for new nurses entering practice. These competencies, along with othersthat are detailed in the environmental scan, were consulted in the development of entry-to-practicepublic health nursing competencies that would provide a guide for faculty in developing a reasonablelevel of student competence in this area of nursing.The environmental scan also included literature on the health needs of Canadians, and how thehealthcare system is transforming to meet changing needs. Recently, the rise in chronic illness andthe high costs of acute care have resulted in calls for a greater focus on health promotion anddisease prevention, and for an increase in the amount of community-based service-delivery inCanada (CNA, 2012). In addition, concerns about globalization increasing the threat of communicablediseases worldwide have prompted discussions about the state of public health services in Canada(National Advisory Committee on SARS and Public Health, 2003). Moreover, in response to theCommission on the Social Determinants of Health, and the resulting call by the World HealthOrganization (WHO) to close the gap of health inequities within a generation, graduating registerednurses are expected to have the preparation needed to contribute to this effort (Commission on theSocial Determinants of Health, 2008). Given the changing health needs of the population and theevolving health challenges Canadians are facing, it is imperative that all new nurses enter theworkforce with a sound preparation in public health.4
A Working Group of Public Health Task Force members with experience in competency developmentwas formed to review the environmental scan and create a first draft of competencies. The WorkingGroup and a full Task Force engaged in an iterative process of creating, reviewing, and revisingcompetencies until they produced a first consensus based draft for stakeholder review and revision.CASN used a modified Delphi process with the goal of achieving a broader national consensus on thecompetencies. The first round occurred at a Stakeholder Forum in October 2013. More than 35stakeholders from different areas of public health (nursing education, public health nursing practice,provincial and federal public health associations, national nursing associations, and representativesfrom other health professions) attended the Forum. Attendees participated in a knowledge caféexercise: in small groups the participants were asked to indicate their level of agreement with thecompetency and indicator statements and to provide feedback. Following the knowledge café exercisethe group converged to discuss the competency framework organization.Following the Stakeholder Forum, the Competency Development Working Group reviewed all of thefeedback and produced a second draft of the competencies. Once again, the Working Group and theTask Force engaged in an iterative process until they were prepared to send the document out in asecond attempt to achieve national consensus. During this round of feedback CASN reached out to awider group of stakeholders for feedback using an online questionnaire. For each competency andindicator statement respondents were asked to rate the statement as “essential”, “important”,“somewhat important”, “not at all important”, or to indicate if they did not know. In order to achieveconsensus, the Task Force established that 75% of responses should be categorized as “essential” or“important”.CASN sent the online questionnaire to the Deans and Directors of CASN member schools and theStakeholder Forum participants. The members of the Task Force were asked to circulate the onlinequestionnaire to their colleagues. CASN received 207 responses to the online questionnaire. Themajority of respondents were from universities or colleges (44%), but also included health authorities orhealth centers (18.8%), and regional public health organizations (14%). CASN received feedback from allthe provinces and territories except for the Yukon. More than half of the responses came from Ontario(52.2%). Alberta (11.1%) and British Colombia (9.2%) had the second and third highest response rates.The results of the survey indicated that CASN had reached consensus on all of the competency andindicator statements. The Working Group reviewed the statements that received more “important”than “essential” responses for any issues that might be causing them to be viewed as non-essential. Thegroup also reviewed additional comments from stakeholders. As a result of the online questionnaire,minor revisions were made to this document, in most cases to increase clarity of the competency andindicator statements.This final draft of the competencies was reviewed and approved by the CASN Public Health Task Force,the CASN Standing Committee on Education, and the CASN Board of Directors.5
Entry-to-Practice PublicHealth Nursing Competenciesfor Undergraduate NursingEducation6
Domain1Competency 1Public Health Sciences in Nursing PracticeApplies public health sciences in nursing practiceIndicators1.1Describes the history and current structure of public health, public healthnursing, and the health care system in the context of local communities,Aboriginal peoples, provinces/territories, nationally and globally.1.2Describes federal and provincial/territorial regulatory legislation and policyrelevant to public health nursing.1.3Applies knowledge about the following concepts: the health status ofpopulations, vulnerable populations, population health ethics, cultural safety,determinants of health, social justice, and principles of primary health care.1.4Applies knowledge of strategies for health protection; health promotion(including mental health), communicable and non-communicable disease,injury prevention and, health emergency preparedness and disaster response.1.5Describes the inter-relationships between the individual, family, community,population and system.1.6Articulates the intersection between economic, social, political, cultural andenvironmental factors, and the health of populations to inform healthy publicpolicy.7
Domain2Competency 2Population and Community HealthAssessment and AnalysisAssesses and analyses population and community healthusing relevant data, research, nursing knowledge, andconsidering the local and global context.Indicators2.1Describes the importance of collecting nursing, community, and environmentaldata on the health of populations.2.2Recognizes the impact of the social and environmental/ecologicaldeterminants of health on groups/communities/populations.2.3Uses a population health lens to assess and analyze group/community/population health trends.2.4Participates in group/community/population health assessment and analysisidentifying opportunities and risks by using multiple methods and sources ofknowing in partnership with the client.2.5Recognizes trends and patterns of epidemiological data, to identify gaps inservice delivery, as well as capacities and opportunities for health.8
Domain3Competency 3Population Health Planning,Implementation, and EvaluationParticipates in the planning, implementation, andevaluation of one or more of the following: populationhealth promotion, injury and disease prevention, andhealth protection programs and services within thecommunity.Indicators3.1Uses evidence to inform planning of population health programs and services.3.2Applies health promotion, injury and disease prevention strategies across thelifespan.3.3Participates in the monitoring and evaluation of the outcomes of populationhealth programs and services.9
Domain4Competency 4Partnerships, Collaboration and AdvocacyEngages with partners to collaborate and advocate withthe community to create and implement strategies thatimprove the health of populations.Indicators4.1Engages with the community, in particular populations facing inequities, usinga capacity building/mobilization approach to address public health issues.4.2Collaborates and advocates with the community to promote and protect thehealth of the community.4.3Seeks opportunities to participate in coalitions and inter-sectoral partnershipsto develop and implement strategies to promote health.10
Domain5Competency 5Communication in Public Health NursingApplies communication strategies to effectively workwith clients, health professionals and other sectors.Indicators5.1Applies health literacy when working with clients.5.2Uses social media, community resources and social marketing techniquesappropriately to disseminate health information.5.3Documents population health nursing activities.5.4Uses appropriate communication techniques to influence decision makers.11
GlossaryTermDefinitionAboriginal peoplesIn the Canadian context this term refers to First Nations, Inuit, and Métispopulations (Royal Commission on Aboriginal Peoples, 1996).Capacity buildingThe development of a set of attributes that enable a community to takeaction (MacLellan-Wright et al., 2007).ClientThe term may refer to individuals, families, groups, communities,populations or systems; the way the term is used depends on the contextin which it is used (CPHA, 2010).CollaborationA recognized relationship among different sectors or groups, which havebeen formed to take action on an issue in a way that is more effective orsustainable than might be achieved by the public health sector actingalone (PHAC, 2010).CommunityAn organized group of people bound together by social, cultural, job, orgeographic ties. It may be as simple as a number of families and otherswho organize themselves to survive, or as complex as the worldcommunity with its highly organized institutions (CPHA, 2010).Community ethicsThe branch of philosophy dealing with distinctions between right andwrong, and with the moral consequences of human actions. Much ofmodern ethical thinking is based on the concepts of human rights,individual freedom and autonomy, and on doing good and not harming.The concept of equity, or equal consideration for every individual, isparamount. In public health, the community need for protection fromrisks to health may take precedence over individual human rights, forinstance when persons with a contagious disease are isolated and theircontacts may be subject to quarantine. Finding a balance between thepublic health requirement for access to information and the individual’sright to privacy and to confidentiality of personal information may also bea source of tension (PHAC, 2010).Community developmentThe process of involving a community in the identifying and strengtheningthose aspects of daily life, cultural life, and political life which supportshealth. This might include support for political action to change the totalenvironment and strength resources for health living. It could also bework that reinforces social networks and social support within acommunity or seeks to develop the community’s material resources andeconomic base (CPHA, 2010).Culturally-relevant (andappropriate)This is a process and state of recognizing, understanding, and applyingattitudes and practices that are both sensitive to and correct for workingwith people with diverse cultural socio-economic and educationalbackgrounds, and people of all ages, genders, health status, sexualorientations, and abilities (PHAC, 2010).12
Cultural safetyGoes beyond cultural awareness and the acknowledgement of difference.Surpasses cultural sensitivity (which recognizes the importance ofrespecting difference). It is an understanding of the power differentialsinherent in health service delivery and redressing these inequalitiesthrough educational processes (A.N.A.C., 2009).Disease and injurypreventionMeasures to prevent the occurrence of disease and injury, such as riskfactor reduction, but also to arrest the progress and reduce theconsequences of disease or injury once established. Disease and injuryprevention is sometimes used as a complementary term alongside healthpromotion. (PHAC, 2010).Ecological healthThe connection between healthy functioning ecosystems, the valuableservices they provide, and human health and well-being (MetroVancouver, 2011).Emergency preparednessThe readiness for unexpected lethal or harmful events involving morecasualties than health care infrastructures are normally designed tohandle (CEEP, 2009).Environmental healthEnvironmental health addresses all the physical, chemical, and biologicalfactors external to a person, and all the related factors impactingbehaviours. It encompasses the assessment and control of thoseenvironmental factors that can potentially affect health. It is targetedtowards preventing disease and creating health-supportive environments(WHO, 2013).EpidemiologyThe study of the distribution and determinants of health-related states orevents (including disease), and the application of this study to the controlof diseases and other health problems (WHO, 2013a).Harm reductionTaking action through policy and programming to reduce the harmfuleffects of behaviour. It involves a range of non-judgmental approachesand strategies aimed at providing and enhancing the knowledge, skillsresources and supports for individuals, their families and communities tomake informed decisions to be safer and healthier (BC Harm ReductionStrategies and Services, 2011).Health equityThe absence of unjust, unfair and avoidable systematic inequalities inhealth or in m
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entry-level RN to function at the level of practice of an experienced RN. 2. The entry-level RN works within the registered nursing scope of practice, and appropriately seeks guidance when they encounter situations outside of their ability. 3. The entry-level RN must have the requisite skills and abilities to attain the entry-level competencies. 4.
1. The entry-level RN is a beginning practitioner. It is unrealistic to expect an entry-level RN to function at the level of practice of an experienced RN. 2. The entry-level RN works within the registered nursing scope of practice, and appropriately seeks guidance when they encounter situations outside of their ability. 3. The entry-level RN .
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