The efficiency study reveals a critical need for robust evidence synthesis and clear clinical decision pathways in Nordic population and public health nursing. This scenario is professionally challenging because it requires balancing the imperative to adopt evidence-based practices with the practicalities of implementation within diverse public health settings across Nordic countries, each with its own nuances in healthcare systems and patient populations. Careful judgment is required to ensure that synthesized evidence is not only scientifically sound but also ethically applicable and culturally sensitive. The best approach involves a systematic and transparent process for synthesizing evidence, prioritizing high-quality research, and developing decision pathways that are clearly articulated, accessible to practitioners, and subject to ongoing evaluation. This aligns with the principles of evidence-based practice, which are foundational to professional nursing and public health initiatives. Specifically, in the Nordic context, this approach respects the commitment to equitable healthcare access and the use of public resources efficiently, as mandated by national health strategies and professional nursing codes of conduct that emphasize patient well-being and professional accountability. The development of clear pathways ensures that nursing interventions are consistent, effective, and justifiable, thereby enhancing population health outcomes and public trust. An approach that relies solely on anecdotal evidence or the opinions of a few senior practitioners is professionally unacceptable. This fails to meet the standards of evidence-based practice and risks perpetuating outdated or ineffective interventions. Ethically, it compromises the duty of care to the population by not utilizing the best available knowledge. Another unacceptable approach is the adoption of evidence without considering its applicability to the specific Nordic populations and public health contexts. This can lead to interventions that are not culturally appropriate, feasible, or effective, potentially causing harm or wasting valuable resources. Regulatory frameworks in Nordic countries emphasize the need for interventions to be tailored to local needs and evidence to be critically appraised for relevance. A further professionally unsound approach is the creation of complex, inaccessible decision pathways that are difficult for frontline nurses to understand or implement. This undermines the goal of improving practice and can lead to inconsistent care delivery. It also fails to uphold the professional responsibility to ensure that all nurses have the knowledge and tools necessary to provide high-quality care. Professionals should employ a decision-making framework that begins with a thorough environmental scan of existing evidence and current practices. This should be followed by a critical appraisal of the evidence, considering its quality, relevance, and applicability to the target population. The development of decision pathways should be a collaborative process involving stakeholders, including frontline nurses, researchers, and public health administrators. Finally, a robust system for monitoring the implementation and impact of these pathways, with mechanisms for feedback and iterative refinement, is essential for continuous quality improvement and adherence to regulatory expectations for public health service delivery.

Scenario Analysis: This scenario presents a common challenge for aspiring consultants in Nordic public health nursing: navigating the extensive preparation resources and determining an optimal timeline for credentialing. The complexity arises from the diverse nature of available materials, the varying levels of detail and relevance, and the need to balance thoroughness with efficiency to meet credentialing deadlines. Professionals must exercise careful judgment to avoid superficial preparation or overwhelming themselves with non-essential information, both of which can jeopardize their application and future practice. Correct Approach Analysis: The best approach involves a structured, evidence-based strategy that prioritizes official credentialing body guidelines and reputable academic/professional resources. This entails first thoroughly reviewing the specific requirements and recommended study materials published by the Nordic credentialing body. Subsequently, candidates should identify key themes and competencies outlined in these guidelines and then seek out peer-reviewed literature, established public health nursing textbooks, and relevant national health reports from the Nordic countries. A phased timeline, allocating dedicated blocks of time for foundational knowledge review, in-depth study of specific competencies, practice question engagement, and mock assessments, is crucial. This systematic method ensures comprehensive coverage of essential areas, aligns preparation with credentialing expectations, and builds confidence through progressive mastery. Incorrect Approaches Analysis: Relying solely on informal study groups and anecdotal advice from peers, without cross-referencing official guidelines, is professionally unacceptable. This approach risks focusing on outdated or irrelevant information, potentially leading to gaps in knowledge or misunderstanding of current standards. It lacks the rigor and accountability required for professional credentialing and can result in a superficial understanding of complex public health nursing principles. Adopting a purely self-directed learning approach without any structured timeline or external validation, such as practice exams, is also problematic. While self-direction can be valuable, the absence of a framework can lead to inefficient study habits, procrastination, and an inability to gauge preparedness accurately. This can result in either insufficient preparation or an excessive, unfocused investment of time, neither of which is conducive to successful credentialing. Focusing exclusively on the most recent research publications while neglecting foundational public health nursing principles and established guidelines is another flawed strategy. While staying current is important, a strong understanding of core concepts, ethical frameworks, and regulatory requirements is paramount for effective public health nursing practice and credentialing. This approach risks creating a candidate who is knowledgeable about niche topics but lacks the broad, foundational competence expected by credentialing bodies. Professional Reasoning: Professionals should approach credentialing preparation with a strategic mindset. This involves: 1) Deconstructing the official requirements: Understanding precisely what the credentialing body expects in terms of knowledge, skills, and experience. 2) Resource evaluation: Critically assessing the credibility and relevance of all potential study materials, prioritizing those directly endorsed or aligned with the credentialing body. 3) Structured planning: Developing a realistic and phased study schedule that incorporates review, in-depth learning, and assessment. 4) Self-assessment and adaptation: Regularly evaluating progress through practice questions and mock exams, and adjusting the study plan as needed to address weaknesses. 5) Seeking mentorship: Engaging with experienced professionals or credentialing body representatives for guidance when uncertainties arise.

This scenario is professionally challenging because it requires a nuanced understanding of the specific eligibility criteria for the Comprehensive Nordic Population and Public Health Nursing Consultant Credentialing, which are designed to ensure that only qualified individuals contribute to public health initiatives across Nordic countries. Misinterpreting these criteria can lead to the exclusion of deserving candidates or the inclusion of individuals who do not meet the required standards, potentially impacting the quality and effectiveness of public health services. Careful judgment is required to balance the intent of the credentialing body with the individual circumstances of applicants. The best approach involves a thorough review of the applicant’s documented experience and qualifications against the explicit requirements outlined by the Nordic Public Health Council for this specific credentialing. This includes verifying that the applicant’s professional background demonstrably aligns with the defined scope of population and public health nursing practice within the Nordic context, and that they meet the stipulated educational and professional development benchmarks. This approach is correct because it adheres strictly to the established regulatory framework and guidelines governing the credentialing process, ensuring fairness, transparency, and the maintenance of professional standards. It prioritizes objective evidence of competence as defined by the credentialing authority. An incorrect approach would be to grant eligibility based on a general understanding of public health nursing without verifying specific alignment with the Nordic framework. This fails to acknowledge the unique public health challenges and priorities within the Nordic region, which the credentialing is designed to address. It risks overlooking critical competencies or experience that are specifically valued and required for effective practice in this context. Another incorrect approach would be to assume that experience in a similar role in a non-Nordic country automatically qualifies an applicant, without a formal assessment of equivalency against Nordic standards. While international experience can be valuable, the specific regulatory and cultural nuances of public health in Nordic countries may differ significantly, and a direct transfer of qualifications without due diligence could lead to a mismatch between the consultant’s expertise and the needs of the target population. Furthermore, an incorrect approach would be to prioritize the applicant’s personal assertion of competence over verifiable documentation. The credentialing process relies on objective evidence to ensure the integrity of the qualification. Relying solely on an applicant’s self-assessment, without corroborating evidence, undermines the credibility of the credentialing system and could lead to the certification of individuals who lack the necessary demonstrable skills and knowledge. Professionals should employ a decision-making framework that begins with a clear understanding of the governing regulations and guidelines. This involves meticulously examining the stated purpose and eligibility criteria for the credential. Subsequently, they should gather and critically evaluate all submitted documentation, cross-referencing it against these criteria. When ambiguities arise, seeking clarification from the credentialing body or consulting relevant official guidance documents is essential. The decision should always be grounded in objective evidence and adherence to the established framework, ensuring both fairness to the applicant and the integrity of the credential.

Scenario Analysis: This scenario is professionally challenging because it requires a public health nursing consultant to navigate the complex landscape of data privacy and consent within the context of population health research, while also ensuring the ethical and legal integrity of their work. Balancing the potential benefits of research with the fundamental rights of individuals to privacy and control over their personal health information is paramount. Missteps can lead to significant legal repercussions, erosion of public trust, and harm to participants. Correct Approach Analysis: The best professional practice involves obtaining explicit, informed consent from all individuals whose identifiable health data will be used for the research project. This approach aligns with the core principles of data protection and patient autonomy enshrined in Nordic data protection regulations, such as the General Data Protection Regulation (GDPR) as implemented in Nordic countries, and ethical guidelines for health research. Explicit consent ensures individuals are fully aware of how their data will be used, who will have access to it, and the potential risks and benefits, thereby empowering them to make a voluntary and informed decision. This respects their right to privacy and ensures the research is conducted ethically and legally. Incorrect Approaches Analysis: Using anonymized data without explicit consent, even if the anonymization process is robust, presents an ethical and regulatory risk. While anonymization aims to de-identify individuals, the possibility of re-identification, however remote, can still raise concerns about privacy. Nordic data protection laws often require a legal basis for processing personal data, and while anonymization can sometimes negate the need for consent for certain uses, for direct research participation, explicit consent is the most secure and ethically sound pathway. Proceeding with the research using data collected under a different, unrelated consent agreement is a clear violation of data protection principles. Consent must be specific to the purpose for which data is being collected and used. Using data for a new research project without re-obtaining consent for that specific purpose is a breach of trust and a contravention of regulations that mandate purpose limitation and data minimization. Assuming that consent is implied due to the nature of public health initiatives is a dangerous and legally unsound assumption. Public health goals, while beneficial, do not automatically override individual rights to privacy and control over personal health information. Nordic data protection frameworks emphasize the need for clear, affirmative consent for data processing, particularly for sensitive health data, and do not permit broad assumptions of consent. Professional Reasoning: Professionals should adopt a proactive and transparent approach to data handling and research ethics. This involves thoroughly understanding the applicable data protection laws and ethical guidelines relevant to the specific Nordic jurisdiction. Before commencing any research involving personal health data, a comprehensive assessment of data processing requirements should be conducted. This includes identifying the legal basis for processing, determining the necessity of consent, and designing consent mechanisms that are clear, accessible, and truly informed. When in doubt, seeking legal counsel or consulting with ethics review boards is crucial. The decision-making process should prioritize individual rights and regulatory compliance, ensuring that the pursuit of public health knowledge does not come at the expense of fundamental privacy protections.

This scenario is professionally challenging because it requires the public health nurse consultant to navigate complex ethical considerations and regulatory requirements when assessing and monitoring a vulnerable population across different life stages. Balancing individual privacy with the need for comprehensive data collection, ensuring equitable access to services, and maintaining professional accountability are paramount. The consultant must demonstrate a deep understanding of Nordic population and public health nursing principles, as well as the specific legal and ethical frameworks governing data protection and patient care within the Nordic context. The best approach involves a systematic, evidence-based assessment that prioritizes client well-being and adheres strictly to data protection regulations. This includes obtaining informed consent for all data collection and sharing, utilizing standardized assessment tools appropriate for each life stage, and establishing clear protocols for ongoing monitoring and intervention. The justification for this approach lies in its alignment with core public health ethics, which emphasize beneficence, non-maleficence, justice, and respect for autonomy. Furthermore, it directly addresses the regulatory imperative to protect personal health information, ensuring that data is collected, stored, and used responsibly and transparently, in accordance with Nordic data privacy laws such as GDPR, which are fundamental to maintaining public trust and ensuring effective, ethical public health interventions. An approach that relies solely on historical data without re-assessment fails to account for changes in an individual’s health status or life circumstances, potentially leading to outdated or inappropriate interventions. This neglects the ethical duty of beneficence and can violate regulatory requirements for current and accurate record-keeping. Another incorrect approach, which involves sharing detailed client information with external agencies without explicit, informed consent, constitutes a significant breach of privacy and violates data protection laws. This erodes trust and can have severe legal and professional repercussions. Finally, an approach that focuses only on acute health issues and overlooks psychosocial factors or preventative care presents an incomplete picture of the individual’s health. This is ethically problematic as it fails to address the holistic needs of the client across the lifespan and may not align with public health mandates for comprehensive care and prevention. Professionals should employ a decision-making process that begins with a thorough understanding of the client’s current situation and needs, followed by a review of relevant regulatory and ethical guidelines. They should then identify assessment tools and monitoring strategies that are both effective and compliant. Crucially, obtaining and maintaining informed consent throughout the process is non-negotiable. Regular reflection on practice, consultation with colleagues, and ongoing professional development are essential to ensure continued adherence to best practices and regulatory standards.

This scenario is professionally challenging because it requires the Nordic Population and Public Health Nursing Consultant to integrate complex pathophysiological understanding with the practical realities of public health interventions, all while adhering to the specific regulatory and ethical frameworks governing public health practice in the Nordic region. The consultant must navigate potential conflicts between individual patient needs and population-level health goals, ensuring that decisions are evidence-based, equitable, and compliant with national health legislation and professional codes of conduct. The correct approach involves a systematic assessment that prioritizes understanding the underlying pathophysiology of the observed health issue within the target population. This includes analyzing epidemiological data, identifying risk factors, and considering the biological mechanisms driving the health problem. Based on this comprehensive pathophysiological understanding, the consultant then develops and implements evidence-based interventions that are tailored to the specific needs and context of the Nordic population, ensuring these interventions align with national public health strategies and ethical guidelines for resource allocation and health equity. This approach is correct because it directly addresses the core requirement of pathophysiology-informed decision-making, grounding interventions in scientific understanding and ensuring they are both effective and ethically sound within the Nordic regulatory landscape. It respects the principles of evidence-based practice and population health management mandated by Nordic public health authorities. An incorrect approach would be to focus solely on immediate symptomatic relief without a deep dive into the underlying pathophysiology. This fails to address the root causes of the health issue within the population, potentially leading to ineffective or short-lived interventions and a misallocation of public health resources. It neglects the crucial element of pathophysiology-informed decision-making, which is essential for sustainable public health improvements. Another incorrect approach would be to implement interventions based on anecdotal evidence or popular opinion rather than rigorous scientific and epidemiological data. This disregards the regulatory requirement for evidence-based practice in public health and risks introducing interventions that are not only ineffective but could also be harmful or inequitable. It fails to demonstrate the necessary professional diligence and adherence to established public health protocols. A further incorrect approach would be to prioritize individual patient care models over population-level strategies when addressing a public health concern. While individual care is important, public health nursing consultants are mandated to consider the broader population. A failure to adopt a population-centric perspective, informed by pathophysiology, means that interventions may not reach a sufficient number of individuals to impact the overall health of the community, thus failing to meet the objectives of public health initiatives. Professionals should employ a decision-making framework that begins with a thorough epidemiological and pathophysiological assessment of the population’s health status. This should be followed by a critical review of existing evidence for interventions, considering their feasibility, ethical implications, and alignment with national public health goals and regulatory requirements. Continuous monitoring and evaluation of interventions are also crucial to ensure ongoing effectiveness and adaptation.

Scenario Analysis: This scenario is professionally challenging because it requires a nuanced understanding of the credentialing body’s policies regarding exam performance and the implications for a public health nursing consultant’s professional standing. Balancing the desire to achieve credentialing with adherence to established procedures, especially when facing setbacks, demands integrity and a commitment to fair processes. Misinterpreting or circumventing these policies can lead to ethical breaches and undermine the credibility of the credentialing system. Correct Approach Analysis: The best professional approach involves a thorough review of the official credentialing body’s published blueprint, specifically sections detailing scoring methodologies, pass/fail criteria, and the precise conditions under which a candidate is eligible for a retake. This approach is correct because it directly aligns with the principles of regulatory compliance and professional accountability. Adhering strictly to the documented policies ensures fairness to all candidates and upholds the integrity of the credentialing process. The blueprint serves as the definitive guide for all aspects of the examination, including retake eligibility, which is typically contingent on factors such as achieving a minimum score threshold or demonstrating specific competencies, rather than subjective appeals or external circumstances. Incorrect Approaches Analysis: One incorrect approach involves attempting to appeal the scoring or retake eligibility based on personal circumstances or perceived unfairness without concrete evidence of a procedural error by the examination administrators. This fails to acknowledge that credentialing policies are designed to be objective and consistently applied. Ethical failures include attempting to gain an advantage through non-standard means and disrespecting the established framework. Another incorrect approach is to assume that a certain number of attempts automatically grants eligibility for a retake, without consulting the official policy. This demonstrates a lack of due diligence and a misunderstanding of how retake policies are typically structured, which often involve specific waiting periods, additional training requirements, or a limited number of allowed attempts before more stringent measures are imposed. This approach risks violating the credentialing body’s rules and could lead to disqualification. A further incorrect approach is to seek informal advice from peers or mentors about retake eligibility without verifying the information against the official documentation. While well-intentioned, informal advice can be inaccurate or outdated, leading to misinterpretations of policy. This can result in actions that are not in compliance with the credentialing body’s regulations, potentially jeopardizing the candidate’s standing. Professional Reasoning: Professionals should always prioritize consulting official documentation for policies and procedures. When faced with uncertainty about exam performance or retake eligibility, the first step should be to locate and meticulously review the credentialing body’s official handbook, website, or published guidelines. If clarification is still needed after reviewing the documentation, the appropriate course of action is to contact the credentialing body directly through their designated channels for official interpretation. This ensures that decisions are based on accurate, up-to-date information and are in full compliance with the established regulatory framework.

The efficiency study reveals a concerning trend in medication errors within a Nordic healthcare setting, specifically related to the prescribing support provided by public health nurses. This scenario is professionally challenging because it directly impacts patient safety and requires nurses to navigate complex ethical and regulatory landscapes concerning medication management and their scope of practice. Public health nurses in Nordic countries operate under specific national legislation and professional guidelines that define their responsibilities in medication support, necessitating a deep understanding of these frameworks to ensure safe and effective patient care. The correct approach involves the public health nurse meticulously documenting all medication-related advice and support provided to patients, including the rationale for the advice, any consultations with prescribers, and the patient’s understanding and agreement. This approach aligns with the principles of professional accountability and patient-centered care mandated by Nordic healthcare regulations. Specifically, it upholds the requirement for clear communication, informed consent, and the nurse’s responsibility to act within their defined professional scope, which often includes providing education and support regarding prescribed medications. Documentation serves as a crucial record of care, protects both the patient and the nurse, and facilitates continuity of care and quality improvement initiatives. This practice is supported by national nursing professional standards that emphasize accurate record-keeping as fundamental to safe practice. An incorrect approach would be for the public health nurse to rely solely on verbal communication with patients regarding medication adjustments without any written record or confirmation of prescriber consultation. This fails to meet the regulatory requirement for comprehensive documentation of patient interactions and advice, increasing the risk of miscommunication and medication errors. It also potentially exceeds the nurse’s scope of practice if medication adjustments are made without explicit prescriber authorization, violating prescribing support guidelines. Another incorrect approach would be for the nurse to delegate medication-related advice to an unqualified assistant without direct supervision or verification. This directly contravenes regulations concerning the delegation of healthcare tasks and the professional responsibility of the nurse to ensure that all patient care, especially concerning medication, is delivered by competent individuals. It also bypasses essential safety checks and the nurse’s ultimate accountability for patient outcomes. A further incorrect approach would be for the public health nurse to assume that a patient’s understanding of medication instructions is sufficient without actively verifying it through open-ended questions and observation. This overlooks the ethical imperative to ensure patient comprehension and autonomy, and it fails to address potential barriers to understanding, such as language differences or cognitive impairments, which are critical considerations in public health nursing. This approach neglects the proactive role nurses must play in medication safety. Professionals should employ a decision-making framework that prioritizes patient safety, adheres strictly to national regulatory frameworks and professional guidelines, and emphasizes clear, documented communication. This involves a continuous assessment of the patient’s needs, understanding of their treatment plan, and the nurse’s own scope of practice. When in doubt, consultation with a prescriber or senior colleague is paramount, with all interactions and decisions meticulously recorded.

The efficiency study reveals a critical juncture in the implementation of a new public health initiative aimed at improving maternal and child health outcomes across several Nordic municipalities. The challenge lies in ensuring that the initiative’s core knowledge domains, as defined by the Nordic Council of Ministers’ guidelines for public health nursing, are consistently and effectively integrated into the daily practice of nursing consultants. This scenario is professionally challenging because it requires balancing the pursuit of efficiency gains with the absolute imperative of maintaining high-quality, evidence-based care that adheres to established professional standards and ethical principles. Misinterpreting or misapplying the core knowledge domains could lead to suboptimal patient care, inequitable service delivery, and a failure to meet the initiative’s intended public health goals. Careful judgment is required to ensure that efficiency measures do not compromise the depth and breadth of nursing expertise. The best approach involves a comprehensive review and adaptation of existing training materials and protocols to explicitly embed the core knowledge domains of the Nordic Council of Ministers’ guidelines. This includes ensuring that all nursing consultants receive ongoing professional development that directly addresses these domains, with a focus on practical application and critical thinking. This approach is correct because it directly aligns with the regulatory framework’s emphasis on standardized, evidence-based practice and continuous professional development. By explicitly integrating the core knowledge domains into training and practice, it ensures that nursing consultants are equipped with the necessary competencies to deliver effective public health interventions, thereby upholding the ethical obligation to provide competent and safe care. This proactive strategy fosters a culture of learning and adherence to best practices, directly supporting the initiative’s objectives. An incorrect approach would be to assume that existing general nursing competencies are sufficient to cover the specific core knowledge domains of the Nordic public health nursing guidelines. This fails to acknowledge the specialized nature of public health nursing and the specific requirements outlined by the Nordic Council of Ministers. It risks leaving gaps in knowledge and skills, potentially leading to the delivery of care that is not fully aligned with current best practices or regulatory expectations. Another incorrect approach would be to prioritize efficiency metrics above all else, such as reducing training time or simplifying complex protocols without ensuring that the core knowledge domains are adequately covered. This approach is ethically flawed as it prioritizes cost-saving or speed over the quality of care and patient safety. It disregards the professional responsibility to ensure that all practitioners are adequately prepared to meet the specific demands of public health nursing. A further incorrect approach would be to delegate the responsibility for understanding and applying the core knowledge domains solely to individual nursing consultants without providing structured support, updated resources, or standardized training. While individual initiative is valuable, this approach creates a risk of inconsistent application and understanding of critical knowledge areas, potentially leading to disparities in care quality across different municipalities. It fails to establish a robust system for ensuring consistent adherence to the regulatory framework. Professionals should employ a decision-making framework that begins with a thorough understanding of the relevant regulatory guidelines and professional standards. This involves identifying the specific core knowledge domains required for the initiative. Next, they should assess the current state of knowledge and practice among the nursing consultants in relation to these domains. Based on this assessment, they should develop and implement targeted strategies for training, resource development, and ongoing support that directly address any identified gaps. Finally, they must establish mechanisms for monitoring and evaluating the effectiveness of these strategies, ensuring continuous improvement and adherence to both regulatory requirements and ethical obligations to provide high-quality public health services.

The efficiency study reveals a need to optimize the delegation of tasks within a public health nursing team serving a Nordic population. This scenario is professionally challenging because effective delegation requires a nuanced understanding of individual team members’ competencies, the specific needs of the patient population, and the regulatory framework governing nursing practice and public health initiatives within the Nordic context. Misjudgments in delegation can lead to compromised patient care, team burnout, and regulatory non-compliance. The best approach involves the lead public health nurse conducting a thorough assessment of each team member’s skills, experience, and current workload, alongside a clear understanding of the specific public health program’s objectives and the patient population’s needs. This assessment informs the strategic assignment of tasks, ensuring that delegated responsibilities align with the competence of the individual and the requirements of the task, thereby maximizing efficiency and patient outcomes. This aligns with the Nordic principles of patient-centered care and the ethical imperative to ensure safe and effective service delivery, as often underpinned by national nursing professional standards and public health directives that emphasize accountability and competence-based practice. An approach that delegates tasks solely based on availability or perceived ease without a formal assessment of competence risks assigning duties beyond an individual’s scope or expertise, potentially compromising patient safety and the quality of public health interventions. This fails to uphold the regulatory requirement for nurses to practice within their competence and to ensure that delegated tasks are appropriate for the skill level of the recipient. Another unacceptable approach is to delegate tasks without providing clear instructions, necessary resources, or adequate supervision. This can lead to confusion, errors, and a lack of accountability, undermining the effectiveness of the public health program and potentially violating guidelines that mandate clear communication and support structures for delegated activities. Finally, delegating tasks that are inherently the responsibility of a registered nurse, without considering the specific legal and professional boundaries for other healthcare professionals or support staff, is a significant regulatory failure. This overlooks the established scope of practice for various roles within the healthcare system and could lead to unauthorized practice. Professionals should employ a decision-making process that prioritizes a comprehensive needs assessment (of patients, population, and program), followed by an individual assessment of team members’ capabilities and limitations. Clear communication of expectations, provision of necessary support, and ongoing evaluation of delegated tasks are crucial components of effective leadership and delegation in public health nursing.