NURS 420- CH 1

Growing Health Concerns

◦Costs of medical care

◦Quality and safety of services

◦Warnings about bioterrorism

◦Global public health threats (infectious diseases, contaminated food, pandemics)

◦Available and affordable health insurance/access

◦US health & life expectancy is worse than other high-income countries although we spend more per person than any other country

◦Less is spent on social services

Public Health Practice

◦Historically, gains in the health of populations have come largely from public health efforts, for example,

◦Safety and adequacy of food supplies;

◦Provision of safe water;

◦Sewage disposal;

◦Public safety from biological threats; and

◦Personal behavioral changes, including reproductive behavior

◦CDC’s (1999) Ten Great Public Health Achievements in the 20^th Century

CDC’s (1999) Ten Great Public Health Achievements in the 20^th Century: these areas featured include

immunizations

motor vehcile safety

workplace safety

control of infectious diseases

safer and healthier foods

healthiers mothers and babies

family planning

flurordiation of drinking water

tobacco aas a health hazard

declines in death from heart disease and stroke

Definitions in Public Health- In 1998 the IOM published a report on the future of public health in which PH was defined as:

◦“what we, as a society, do collectively to assure the conditions in which people can be healthy” (IOM. 1988, p. 1).

Definitions in Public Health- ◦The committee stated the mission of PH was:

◦“to generate organized community efforts to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health” (IOM, 1988 p. 1; Williams, 1995).

◦Accomplished by many groups (public & private) & individuals, with special function of the government “to see to it that vital elements are in place and the mission is adequately addressed

Public Health Core Functions:

Assessment

Policy development

Assuranace

Public Health Core Functions: Assessment

◦ systematically collecting data on the population to monitor the health of a population, and making information available about the health of the community

Public Health Core Functions: Policy development

◦ providing leadership in developing laws & policies that support the health of the population based on scientific evidence

Public Health Core Functions: Assurance

◦ role of public health in ensuring that adequate health care personnel and services are accessible, especially to those who might not normally have them

Also refrers to making sure that a complete public health and personal health care workforce is available.

Categories of Public Health Workforce Competencies

◦Analytic/assessment

◦Policy development/program planning

◦Communication

◦Cultural competency

◦Community dimensions of practice

◦Basic public health sciences

◦Financial planning and management

◦Leadership and systems thinking

System thinking

looks at how an individual or unit interacts with other organizations or systems, useful in examining cause and effect relationships.

Quality Improvement Efforts in Public Health- Public Health 3.0 Initiative

◦new era of enhanced and broadened public health practice that goes beyond traditional public health department functions and programs

◦Emerged after recognition that life expectancy was beginning to decline 

Public Health 3.0 Initiative: Key features

◦Focus on prevention at the total population level or community-wide prevention

◦To improve social determinants of health (housing, transportation, safe environments, access to health foods, economic development, and social support)

◦To engage multiple sectors and community partners to generate collective impact

Public Health Nursing as a Field of practice

◦Defined as “the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences” (APHA-PHN, 2013).

◦A specialty practice within nursing and public health.

◦Focuses on improving population health by emphasizing prevention and attending to multiple determinants of health.

◦Often used interchangeably with community health nursing, this nursing practice includes advocacy, policy development, and planning, which addresses issues of social justice

Characteristics that Distinguish Public Health Nursing as a Specialty

◦Population-focused

◦Community-oriented

◦Health and prevention focused

◦Interventions at the community and/or population level

◦Concern for the health of all members of the population or community, particularly vulnerable populations

Population-focused

primary emphasis is on populations whose members are free-living in the community as opposed to those who are institutionalized.

Community-oriented:

there is concern for the connection between the health status of the population and the environmnet in which the population lives (physical, biological, sociocultural). There is an imperative to work with members of the community to carry out core public health function.

Health and preventative focus:

the primary emphasis is on strategies for health promotion, health maintenance, and disease prevention, particularly primary and secondary prevention.

Interventions are at the community or population level:

Target populations are defined as those living in a particular geographic area or those who have particular characteristics in common and political processes are used as a major intervention strategy to affect public policy and achieve goals.

Population focused nursing:

includes assesing to determine needs, intervening to protect and promote health, and preventing diseae within a specific population.

The community or a population

◦(an aggregate who shares one or more personal or environmental characteristics in common) within the community is the “client” in community

◦i.e. geography or special interest or circumstance

Population as a collection of individuals who share one or more personal or environmental characterustics. Members of a community who can be defined in terms of geography, special intrest or circumstance can be seen as constituating a population.

◦Subpopulations

◦high risk group within the larger population

◦Population-focused community-based practice – problems are defined and solutions are implemented for or with a defined population or subpopulation (nursing process)

Subpopulation subsets of the population who share similar charcteristics. Often there are subpopulation or high risk groups within the larger population.

Population-focused community based practice:

problems are defined by (assessments or diagnosis), annd solutions (interventions), such as a policy developmeny or providing a particular preventaive service, are implemented for or with a defined population or subpopulation.

Community based nurse clinicians or nure practioners

focus on indivulas they see in either a home or clinic setting. the focus is on an indivula person or family ina sub population. The providers emphasis is on defining and resolving a problem for the indivula; the client is an indivual.

Public health nursing specialist

often define problems at the population oor aggrate level. population-level decision making is different from decision making in clinial care. Are often concerned with more than 1 subpopulation and frequently the health of the whole community.

Community-oriented nursing/ community health nurses

Focus of care: aggreates, communities, populations (public health), can include at-risk or underserved indivuals and familes

Primary goal: health promotion and disease prevention

Nursing activities: usually indirect (program management); can include direct care of at-risk indulvuals and populations

Community-based nursing

Focus of care: indivulas and families

Primary goal: managemnet of acute and chronic conditions

Nursing activities: direct (one-on-one); illnes care- management of acute and chronic conditions in settings where indivulas, familes, and groups live, work, and attend (schools, camps, prison).

Public health nurses

focus on the whole community and look at the effects of community resources on the health of the indivulas, families, and groups. they raise questions about communities overall health status and associated factors (enviornmnetals) and working with community to improve the population’s health status.

Community-oriented nursing practice

◦A philosophy of nursing service delivery that involves the generalist or specialist public health and community health nurse.

◦The nurse provides health care through community diagnosis and investigation of major health and environmental problems, health surveillance, and monitoring and evaluation of community and population health status for purposes of preventing disease and disability and promoting, protecting, and maintaining health to create conditions in which people can be healthy

Community-based nursing practice

◦A setting-specific practice whereby care is provided for clients and families where they live, work, and attend school.

◦The emphasis of community-based nursing practice is acute and chronic care and the provision of comprehensive, coordinated, and continuous services.

◦Nurses who deliver community-based care are generalists or specialists in maternal/infant, pediatric, adult, or psychiatric/mental health nursing.