What are the priorities? Please help

[eden]

I am an OB nurse but am looking to get out of the hospital and into public health.

I had an interview and it went well except I feel like I bombed one question. Please help me figure out where I went wrong in my answer.

In the scenario I was supposed to be doing a vaccine clinic at a school. An hour before I leave I get a call that there is lice in another school, someone in the community has an STI and we need to make contacts will sexual partners to be tested/treated, I get a notification to do a well baby visit. Now which on these is top priority?

I said

1) The STI in the community

2) getting notification to parents about the lice

3) rebook the school vaccines for another day if necessary, or do it later that day

4) do the well baby visit the following day so long as all is well with it.

Was my priorities in the right order?

[mclennan, BSN, RN]

Do not rebook or reschedule the vaccine clinic. This may be these kids' one contact with a health care provider of any kind, and likely their school schedules are not flexible. I would have answered:

In the hour I have, I would ask my clerical staff to pull the lice notification letter and address data for the parents of affected kids & start a mailing;

Scheduled the well baby visit for the next day;

Contacted the patient with the STI and ask him/her to start gathering contact information on partners who may have been exposed. Establish a way to get the info - via email or schedule a phone call for immediately after the school vaccine clinic.

I was a PHN for 4 years.

[wish_me_luck, BSN, RN]

I am a new grad, so I do not know the answer...but I have an opinion.

I thought STI, then vaccine clinic, then well baby, then lice. My thinking was STI is first due to spread of disease. Vaccine clinic next because it is planned, well baby because it does not take that long assuming they are established clients, and lice...if it is head lice, it is spread by contact and they do not carrying disease. It can also take a while to get rid of.

Anyone else know, that works at the health dept?

[amoLucia]

There's another current post running by a student asking for help in prioritorizing nsg care plan goals. Rule of thumb thinking for answers is to think current before 'risk at', acute before chronic, with the ABC protocol (airway, breathing, circulation) tossed in.

With that in mind, I agree with first poster. The clinic is already in progress, the lice are present but can be stopped with quick action, the STD is more of an already-established problem, and the well-baby is assumed to be stable.

Sounds reasonable to me.

[mclennan, BSN, RN]

In the reality of Public Health nursing, many by-the-book nursing theories and strategies DO NOT APPLY. My answer keeps reality in mind.

You would be LAMBASTED for canceling a vaccine clinic at a school with an hour's notice. PH's focus is on prevention and populations; if it's a gnarly flu season forecasted, that free flu shot might be the only way for scads of kids to get the vaccine at all. When I did vaccine clinics at schools I also noticed possible abuse, neglect, malnutrition and other conditions like lice, impetigo, pinkeye, etc.

There is nothing you can do in ONE HOUR before the vaccine clinic that's gonna magically stop the STI. Gathering data and assessing potential exposures has to happen first. That must be done carefully and with discretion.

PH nursing differs from other kinds of nursing as you apply theories of primary, secondary and tertiary prevention to populations - using demographic data, rather than assigning acuity to individuals using Maslow. I highly recommend taking a look at this (and referencing it as often as possible in cover letters & interviews:)

http://www.health.state.mn.us/divs/cfh/ophp/resources/docs/wheelbook2006.pdf

[eden]

Thanks for the links, that is really most helpful.

It was a hep B clinic in this scenario, as it is given in the 4th grade here not at birth. I didn't realize that it would be an issue since it was a routine vaccine but I definitely see your point and will keep this in mind for future interviews