The Office of Public Health Nursing fulfills the three core functions of public health, assessment, assurance and policy development, as they pertain to public health nursing. Whether the nursing professional is in one of the schools, towns, homes, clinics, agencies or task forces within Bergen County, our public health nursing activities are geared to meet the mandates of the core functions.
An important responsibility of the nursing staff is fulfilling various leadership roles in the Partnership for Community Health in groups such as the Improve Preventive Health Services Goal Team, the Increase Childhood Immunizations Goal Team, and the Increase Physical Activity and Improve Nutrition Goal Team. Participation in this community health improvement project can ultimately delay or prevent the onset of chronic diseases, prevent vaccine preventable diseases, and facilitate early detection of diseases, enabling a better prognosis. These outcomes forward public health goals and offer an alternate, complementary and synergistic avenue to meeting nursing program objectives. Program descriptions and statistical analyses follow.
The Communicable Disease Control Program is a countywide protection service by which the department works directly with the state, hospitals, and laboratories to communicate and respond to communicable diseases that may occur in Bergen County. Examples of these are HIV/AIDS, rabies and TB. The program reported 319 notifiable communicable diseases to the NJDHSS (New Jersey Department of Health and Senior Services), a 27% increase over 1998. The increase was due to an improved reporting system. Two hundred and twenty-one (221) were investigated directly by the department, and 98 were forwarded to municipal nurses for follow-up activities. The largest number of cases were intestinal diseases, i.e., Salmonella and Giardiasis, followed by hepatitis C and hepatitis B.
The Office of Public Health Nursing and the Environmental GIS (Geographic Information System) Program have worked collaboratively on the development of a Communicable Disease Database System. The short-term goal was realized by having the database implemented by the end of January 1998. The use of computerized geographic plotting technology is being employed as a tool to map the cases of reportable communicable diseases in the county such as TB. The mapping is used to track the number of new cases by specific locations, identify trends, alert appropriate public health response and plan resources.
In 1999, there was a decrease in the number of confirmed cases of animal rabies from 32 in 1998, to 16. The decrease reflects the change from a milder winter to a colder one, resulting in less mobility for animals and less contact with humans. Staff assured compliance with the post exposure rabies protocols for the individuals within its jurisdiction.
The countywide TB (Tuberculosis) Control Program, in collaboration with Bergen Regional Medical Center, offers a comprehensive TB treatment clinic, case management with individual service care plans, contact identification, and Mantoux (TB) testing certification. This year’s activities included:
- Maintenance of a high compliance with drug therapy for 58 active TB cases
- Continuation of DOT (Directly Observed Therapy) on all newly diagnosed clinic TB patients in accordance with NJDHSS regulations. DOT is a TB case management intervention carried out to ensure newly diagnosed patients comply with medication. As part of the effort to maximize local resources and promote strategic alliances, the department conducted an in-service program on DOT procedures. Since persons with active TB may also be HIV positive, HIV counseling and testing and case management services are offered as part of the DOT intervention.
The STD (Sexually Transmitted Disease) Program is a collaborative effort among the department, Hackensack University Medical Center and the NJDHSS. Patients are tested for STDs and counseled on the transmission and prevention of STD infections. They are also offered the opportunity for HIV testing and counseling. The most frequently diagnosed STDs in 1999 were genital warts
(39 cases), Gordnerella (15 cases), and Gonorrhea (10 cases). Total morbidity for each STD has not significantly changed from 1998.
During 1999, total clinic visits (312) and new patient visits (168) were down 9% and 24% respectively from 1998. This may be attributable to a better-informed public regarding safer sex practices and the increase in STD testing and treatment by other providers such as Planned Parenthood.
The HIV (Human Immunodeficiency Virus) Counseling and Testing Site continues to provide services to the public through its main office in Hackensack and multiple off-site locations. During 1999, 2,049 individuals were counseled, and 1,960 were tested for HIV. Thirty-two cases tested positive, the same number as in 1998.
Case management is offered to all clients testing positive and to high-risk individuals who test negative. The HIV Site anticipates that the newly expanded Bergen County Jail will increase the demand for HIV services at that facility.
The Immunization Management Program is a health protection program to prevent influenza and pneumonia in older adults, vaccine-preventable diseases in children, and bloodborne infections in employees in the public sector. The older adult and childhood programs are reported under Interlocal Contracts.
The Bloodborne Pathogens Program and Adult Hepatitis B Vaccination Program is a contracted service that provides training in accordance with the PEOSH standard 29CFR Part 1910.1030 to all public employees whose jobs place them at risk. Complying with the law and informing and educating people about health issues protects health and ensures the safety of both the public and personal healthcare workforce. The program provides the development and delivery of Exposure Control Plans as required by state statute, counseling in exposures, record keeping, vaccinations for employees requesting them, and follow-up for compliance.
In 1999, contracting for this service were: 49 municipalities, 33 public school districts, 9 Bergen County departments, the Bergen County Special Services School District, including Bergen County Technical Schools, and Bergen County Community Action Program. A total of 3,265 school employees and 5,172 municipal and county employees attended the annual retraining. Four municipal, county and school Exposure Control Plans were completed, and 617 hepatitis B vaccinations were administered. Of those vaccinated, 36% were municipal employees, 14% county employees, and 50% school district employees. In 1999, the program began to provide regional hepatitis B vaccination programs in six selected public school districts to increase accessibility and population based health services. Through strategic follow-up, the rate of compliance has increased for completion of the hepatitis B vaccination series of three shots.
The Bergen County Breast and Cervical Cancer Screening Program, which began in September 1996, provides breast and cervical cancer screenings to resident women age 50 and older who are low income, uninsured or underinsured. The program increases women’s awareness of health issues and provides access to services for county residents who typically have difficulty accessing preventive health services.
The screening program was the first grant awarded with support from the Partnership for Community Health. The department coordinates the program, including a countywide coalition that acts as an advisory body. Screening services are provided by five community hospitals: Englewood Hospital Medical Center, Hackensack University Medical Center, Holy Name Hospital, Pascack Valley Hospital and The Valley Hospital.
The program is conducted with the Office of Health Promotion, which provides outreach and education. In 1999, 358 clients were screened, and three clients were diagnosed, referred and followed up for breast cancer. More than 50% of program participants identified themselves as from minority racial or ethnic populations. In an effort to reach these clients more effectively, translators are available to assist clients through the screening and follow-up process. Educational materials are available in Spanish, Polish and Korean.
The Nonpublic School Nursing Program has been a successful contractual arrangement among local boards of education, nonpublic schools and the department. It provides school nursing service and incorporates health promotion and primary prevention services (i.e., screening, referral, follow-up and individual counseling).
By June 1999, 39 nonpublic schools in 22 towns had contracted with the department for direct and/or supervisory nursing services. Nursing supervision provides school nurses with a system of peer support and supervision in the form of monthly in-services for skills updates, wellness training, five-day-a-week, on-call phone consultation for unusual health issues and more. A total of 1,077 hours of nursing supervision time was recorded for the 1998-99 school year.
The Special Child Health Services (SCHS) Program provides case management for children with special needs and their families. A special needs child is any child from birth to age 21 who has a birth defect, a serious illness, difficulty walking, talking, and understanding, or is at risk of developing a disabling condition.
In 1999, 1,425 children were referred to the SCHS unit, a 2% increase over 1998. A total of 1,676 children were served, including both new and continuing clients. Eight hundred twenty-six (826) children received case management services; of these, 18 children were on Medicaid waivers, and 26 received funding from the Catastrophic Illness for Children Relief Fund Program. Another remaining 850 children received Service Coordination under the Part C Early Intervention Program for infants and toddlers with disabilities or developmental delays.
A total of 883 visits were made to visit families and children in their homes for the provision of case management or service coordination. Home visits facilitate participation and ease the burden for the family during the assessment and follow-up phases of case management. In addition, program staff assisted families with the completion of NJ KidCare applications and in securing other services through community agencies.
In response to new initiatives from the federal government and NJDHSS, Special Child Health Services formed a partnership with state, county and local departments of education to better address the transition needs of 3 to 5-year-old children requiring special education services.
Under current state regulations, there is a requirement for the provision of municipal public health nursing services. The Office of Public Health Nursing offers Interlocal Contracts for required municipal health services and other population-based health services such as immunization and training. In 1999, 24 municipalities established Interlocal Contracts with the department for direct nursing services, nursing supervision and/or population-based health services. Activities include health planning, coordination among local health agencies and other health providers, and providing cost-effective, quality health services in the areas of child, adult and employee health. Following are the service areas provided under Interlocal Contract agreements.
Overall, fewer children attended Child Health Services in 1999, probably due to the availability of primary care coverage of uninsured children through NJ KidCare.
Child Health Services (well child health assessment visits; immunizations; screening: lead, developmental, vision and hearing)
- 3,264 immunizations administered (1,201 children immunized)
- 510 lead risk assessments (271 blood lead screenings)
- 1,458 children served (2,258 total visits)
The Adult Health Consultation Program seeks to inform, educate and empower people about health issues, addressing one of the essential public health services.
Adult Health Consultation Programs (health risk assessments; counseling; screening: blood pressure, height/weight, referral and follow-up)
- 1,889 clients served (9,653 client visits)
- 572 new clients
- 416 referrals to a higher level of care
Employee Health Services serve Bergen County employees and visitors at the Bergen County Justice Center and Court Plaza (first aid, injury case management, emergency response and health promotion/disease prevention counseling).
- 2,331 client visits
- 156 injury assessments and treatment/referrals
- 113 first aid treatment/referrals
- 1,459 health counseling sessions
The Adult Influenza and Pneumococcal Program consists of the purchase and/or administration of vaccine and coordination of the programs. The program allows for the economical purchase of vaccine for other public health jurisdictions. In 1999, 37 towns participated in the flu program, and 1 Bergen County school district and 30 towns participated in the pneumococcal program. Flu vaccine was administered by departmental nurses at municipally sponsored clinics to 2,192 persons, and pneumococcal vaccine to 225 persons.
In 1999, 749 flu vaccines were administered at county sponsored programs, 290 above 1998, for an increase of 63%. The increase helped the Partnership achieve its goal to increase vaccinations by 10% above last year. The increase can be attributed to eight additional flu programs. Working through the Partnership for Community Health proved beneficial in networking with other agencies, hospitals, and senior organizations, providing a celebrity flyer, and developing a regional calendar for referrals. These strategies linked people to personal health services, assured the provision of health care, and increased accessibility and quality of population based health services.
The Childhood Immunization Program is provided to towns as part of an Interlocal Contract for compliance to state public health regulations. During 1999, the program audited school health records at 76 preschool and primary schools. This is necessary to assure and monitor adherence to state immunization law and to assess the true age-appropriate immunization levels of a given community. Results confirmed a 97.8% compliance rate with state law at time of school entrance. However, a retrospective sample study of second-graders showed an age 2 compliance rate of only 74.1%. Although this represents an increase from 1998’s age 2 compliance rate of 68.6%, it falls short of the state and national goal of 90%. Currently, the low age 2 immunization level is being addressed through the Increase Childhood Immunizations Goal Team of the Partnership for Community Health.
The Nursing Educational Services is dedicated to continuous quality improvement of public health nursing services (i.e., Maternal Child Health Services, Adult Health Consultation, Communicable Disease Control and School Nursing). Nursing in-service programs enhance the level of expertise for staff, 35 participating municipalities and agencies, and 39 nonpublic schools. In 1999, nursing in-service education provided 12 programs on topics including cancer screening for women, mental health and addiction problems in the school-age child, and holistic/alternative medicine. Other 1999 activities included:
• A collaborative presentation by Nursing Educational Services, the Family Service Association of New Jersey, and the Hackensack Police Department to approximately 80 cadets from the Bergen County Police and Fire Academy, on community resources and referrals
• Ongoing development of a system for distance learning including satellite and audio conferences
• A collaborative agreement with the Hackensack Health Department to precept a student from St. Joseph’s College studying for her MSN.