To characterize steady-state indinavir pharmacokinetics in cerebrospinal fluid and plasma, 8 adults infected with human immunodeficiency virus underwent intensive cerebrospinal fluid sampling while receiving indinavir (800 mg every 8 hours) plus nucleoside reverse transcriptase inhibitors. Nine and 11 serial cerebrospinal fluid and plasma samples, respectively, were obtained from each subject. Free indinavir accounted for 94.3% of the drug in cerebrospinal fluid and 41.7% in plasma. Mean values of cerebrospinal fluid peak concentration, concentration at 8 hours, and area under the concentration-time profile calculated over the interval 0 to 8 hours [AUC(0-8)] for free indinavir were 294 nmol/L, 122 nmol/L, and 1616 nmol/L x h, respectively. The cerebrospinal fluid-to-plasma AUC(0-8) ratio for free indinavir was 14.7% +/- 2.6% and did not correlate with indexes of blood-brain barrier integrity or intrathecal immune activation. Indinavir achieves levels in cerebrospinal fluid that should contribute to control of human immunodeficiency virus type 1 replication in this compartment. The cerebrospinal fluid-to-plasma AUC(0-8) ratio suggests clearance mechanisms in addition to passive diffusion across the blood-cerebrospinal fluid barrier, perhaps by P-glycoprotein-mediated efflux.

Ten recommendations are proposed for key skill sets and necessary preparation for faculty to effectively teach C/PHN in baccalaureate schools of nursing.

ObjectiveA collaborative research team of community/public health nursing faculty and public health nurses surveyed public health nurses to explore knowledge, skills, attitudes, and application of the Quad Council Competencies for Public Health Nurses (QCC‐PHN).MethodsEvaluate the knowledge, skills, attitudes, and application of the 2011 QCC‐PHN by public health nurses.DesignA descriptive, cross‐sectional design was used to answer the hypothesis related to the study objective. A convenience sample of 308 public health nurses completed an online survey.MeasurementsANOVA was used to determine the difference between the knowledge, skills, attitudes, and application of community/public health nurses (C/PHNs) regarding the QCC‐PHN based on nursing specialty preparation, years of nursing experience, and years of C/PHN experience.ResultsC/PHNs are described and differences in knowledge, skills, attitudes, and application are delineated. A statistically significant difference was found in knowledge and attitude based upon years of C/PHN experience.ConclusionsRecommendations are proposed for increasing the QCC‐PHN awareness, implementation, and evaluation to effectively enhance the practice of nursing C/PHN.

Enhanced and consistent emphasis on population/global health, and interprofessional content throughout nursing curricula is necessary to prepare providers for practice in global settings. Incorporation of global and interprofessional competencies should be considered in the revision of competencies for PHN practice to enhance productive contributions to community health outcomes. Consideration of proper placement of content gaps within basic and advanced nursing education as well as leveling for community/public health nursing practice needs to be addressed by nursing education and practice. In the interim, a special course or elective may be appropriate, especially for schools having clinical nursing practicums in international settings. Clinical evaluation in low-resource settings needs to be enhanced and aligned with competencies.

In summary, improved population health, population focused care, and community-based networks are the objectives of health care delivery systems. Community/public health nursing education, practice, and research must be re-examined, re-focused, and re-designed to address the challenges of an expanding 21st century health care delivery to populations and communities. Common standards are in place to be utilized by academia, practice and research. With a unified front, C/PHN can collectively play an important transformative role and go forward to meet the ever expanding challenges of the 21st century populations and communities. The Association of Public Health Nurses (APHN) and the Association of Community Health Nurse Educator (ACHNE) have a joint meeting planned in June 2016 in Indianapolis. Please bring your colleagues, stakeholders, and community partners to join the voices of C/PHN to make a positive impact on the changing health care environment through our education, practice and work.