title: The role of public health nurses in bioterrorism preparedness.
abstract: BACKGROUND
  Public health nurses have a central function in the public health system. Nurses conduct disease surveillance, which is an important first step in recognizing diseases caused by bioterrorist agents. Unfortunately, the current public health infrastructure and expectations for public health nurses are not clearly defined and therefore pose serious difficulties for conducting disease surveillance. Increased surveillance activities for bioterrorism preparedness add more responsibilities to the work of public health nurses.
  
  
  METHODS
  A qualitative study on disease surveillance was conducted with public health officials at regional and local levels, working in a variety of urban and rural settings in one large public health region in Texas. Data analysis was supported by qualitative research software, The Ethnograph.
  
  
  RESULTS
  The study found that the nurses working at the local level were extremely dedicated to serving their communities, had formed informal partnerships that are essential for disease surveillance, and effectively used informal communication channels to obtain critical surveillance information. The study revealed that nurses had unmet needs and experienced multiple barriers to conducting disease surveillance.
  
  
  CONCLUSIONS
  The study's findings could have implications for public policy and nursing leadership. Defining the structure of the public health system and the scope of public health nurses' responsibilities will serve as the cornerstone for improvement of bioterrorism preparedness.
authors.affiliation: Texas A&M University System, Health Science Center, Rural and Community Health Institute, Quality and Patient Safety Initiatives, College Station, Texas 77840, USA. ralitsa_akins@yahoo.com
authors.forename: Ralitsa B
authors.initials: RB
authors.lastname: Akins
authors.forename: Josie R
authors.initials: JR
authors.lastname: Williams
authors.forename: Rasa
authors.initials: R
authors.lastname: Silenas
authors.forename: Janine C
authors.initials: JC
authors.lastname: Edwards
mesh_terms: D023482:Bioterrorism / Q000517:prevention & control*; D004189:Disaster Planning / Q000458:organization & administration*; D004517:Education, Professional / Q000458:organization & administration; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration; D006801:Humans; D024802:Nurse's Role; D010348:Patient Care Team / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011159:Population Surveillance / Q000379:methods; D011637:Public Health Nursing / Q000458:organization & administration*; D036301:Qualitative Research; D013781:Texas