DESCRIPTIVE ANALYSIS OF THE IMPLEMENTATION OF THE QUAD COUNCIL PUBLIC HEALTH NURSING COMPETENCIES IN A RURAL STATE by Christy Lynn Buttler Nelson A thesis submitted in partial fulfillment of the requirements for the degree of Master of Nursing MONTANA STATE UNIVERSITY Bozeman, Montana April 2007© COPYRIGHT by Christy Lynn Buttler Nelson 2007 All Rights Reserveii APPROVAL of a thesis submitted by Christy Lynn Buttler Nelson This thesis has been read by each member of the thesis committee and has been found to be satisfactory regarding content, English usage, format, citations, bibliographic style, and consistency, and is ready for submission to the Division of Graduate Education. Sandra Kuntz, PhD, APRN BC Approved for the Department of Nursing Elizabeth Nichols, DNS, RN, FAAN Approved for the Division of Graduate Education Carl A. Fox, PhDiii STATEMENT OF PERMISSION TO USE In presenting this thesis in partial fulfillment of the requirements for a master’s degree at Montana State University, I agree that the Library shall make it available to borrowers under rules of the Library. If I have indicated my intention to copyright this thesis by including a copyright notice page, copying is allowable only for scholarly purposes, consistent with “fair use” as prescribed in the U.S. Copyright Law. Requests for permission for extended quotation from or reproduction of this thesis in whole or in parts may be granted only be the copyright holder. Christy Lynn Buttler Nelson April 2007iv ACKNOWLEDGEMENTS I would like to take this opportunity to express my appreciation to my thesis committee chairperson, Dr. Sandra Kuntz. Without her interest, direction, and wisdom this project would not have come to fruition. I’m also grateful to my committee members, Susan Raph and Marylynn Donnelly, for their support, guidance and expertise. Also thank you to my husband, Dan, and my children, Bryce and Claire, for their support and patience during this journey. There were months on end when the dining room table was covered with books, assignments in various states of completion, and articles from numerous projects. Finally, I’m deeply indebted to the public health professionals who shared their time, experiences, and knowledge with me over the past three years. And to the public health nurses who participated in this project, thank you, without your vital contributions this project would not have occurred.v TABLE OF CONTENTS 1. INTRODUCTION TO THE STUDY.............................................................................1 Introduction.....................................................................................................................1 Background.....................................................................................................................3 Problem Statement..........................................................................................................5 Purpose of the Study .......................................................................................................6 Theoretical Framework...................................................................................................6 Significance of the Study..............................................................................................10 Definitions of Terms.....................................................................................................10 Organization of the Remainder of the Study ................................................................11 2. LITERATURE REVIEW ............................................................................................12 Introduction...................................................................................................................12 Description of the Literature Review............................................................................13 Competent Public Health Workforce: History and Development ................................13 Development of Competencies.....................................................................................18 Rural Facet of Competence...........................................................................................19 Current Concern of Competent Public Health Workforce............................................20 Competencies Associated with the COL Core Competences.......................................21 Montana Public Health Nursing and Competency........................................................24 Significance of Competencies to the Public Health Workforce ...................................26 Diffusion of Innovations...............................................................................................27 3. METHODS ...................................................................................................................29 Introduction...................................................................................................................29 Study Design.................................................................................................................29 Convenience Sample.....................................................................................................30 Tool...............................................................................................................................31 Data Collection and Analysis........................................................................................33 Human Subjects Considerations ...................................................................................34 4. RESULTS ......................................................................................................................35 Introduction...................................................................................................................35 Sample Characteristics..................................................................................................36 PHN Competencies Familiarity ....................................................................................40 Implementation of Quad Councils PHN Competencies ...............................................41 Barriers to Implementation of Competencies