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Better defining the role of public health nurses can improve disease surveillance necessary for bioterrorism preparedness

The threat of bioterrorism has become a major issue for public health systems across the United States. Public health nurses typically conduct disease surveillance, which is an important first step in recognizing diseases caused by bioterrorist agents. The current public health infrastructure and expectations for public health nurses are not clearly defined, and therefore pose serious difficulties for conducting disease surveillance in case of a bioterrorism event.

In 2004, researchers, supported by the Agency for Healthcare Research and Quality (HS13715), interviewed 19 public health officials (including nurses) with diverse backgrounds in nursing, medicine, epidemiology, and emergency management, at local and regional levels within one Texas public health region. This region encompassed the metropolitan area of San Antonio, 21 surrounding counties (mainly rural), 1 military installation, and 2 towns on the Texas and Mexico border. The officials were asked about existing and emerging disease surveillance systems and the role of public health nurses in general and in disease surveillance in particular.

Those interviewed said they would be more effective with the aid of a public health nurse and agreed that person-to-person working relationships were the backbone of surveillance. The interviews revealed that public health nurses effectively used informal communication channels (for example in schools, hospitals, day care centers, and nursing homes) to obtain critical disease surveillance information. However, nurses had unmet needs and experienced multiple barriers to conducting disease surveillance. Lack of sufficient funds and electronic equipment, lack of specialized training and education in bioterrorism preparedness, noncompetitiveness of public health position salaries, and the national nurse shortage all create barriers to filling public health positions with appropriately trained nurses. In addition, the operational lines, expectations, and responsibilities for public health nurses are quite confusing, since they serve both public and community health functions.

See "The role of public health nurses in bioterrorism preparedness," by Ralitsa B. Akins, M.D., Ph.D., Josie R. Williams, M.D., R.N., Rasa Silenas, M.D., F.A.C.S., and Janine C. Edwards, Ph.D., in the October 2005 Disease Management — Response 3(4), pp. 98-105.

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