Exam 1

Module 1

First Defense

Community and Prevention

Work upstream to prevent illness, promote wellness, and strengthen communities

Last Defense

Acute Care and Recovery

Provide critical, life-saving care when illness or injury cannot be prevented.

Acute Care

Basic Nursing

Set up to provide an 8 minute convo bandaid/prescription with a magic pill to correct a health issue that requires more than a pill to correct it.

Community/Public Health Nursing

Individuals, Families, Groups, Population

Belief that healthcare extends beyond the hospital

Community and Population Focus

Shift from individuals to communities

Addressing Disparities

Identifying the needs of the most at-risk

Lillian Wald

• Founder of the modern public health nursing → Prevention of illness rather than just treating the disease

Public Heath Nurse

• Prevention of illness rather than only treating disease

• Home visits to provide care where people lived

• Health education to empower individuals and families

• Addressing social factors such as housing, sanitation, education, and poverty that influence health

• Improvements in child health and occupational health

Why is Lillian Wald Important Today

Her philosophy laid the foundation for modern community and public health nursing. Her belief that health is influenced by social and environmental conditions aligns closely with today’s focus on social drivers of health, health equity, population health, and upstream prevention.

Contributions to Public Health

• Henry Street Settlement

• Henry St. Visiting Nurse Services

• School Nurses

• Metropolitan Life

• Child Labor Laws

• NOPHN

• Established Neighborhood playgrounds

Henry Street Settlement

Founded in 1893 by Lillian Wald and Mary Brewster. Lower east side immigrant neighborhood. Actually moved into the neighborhood to reach the members of the community. Patients were mainly Irish, Italian, Jewish, and Chinese.

Henry St Visiting Nurse Services

Began to make house calls especially during the depression and the Spanish flu pandemic and later families affected by Polio

School Nurses

15-20 students a day were sent home but no one followed up. In one one 1,000 out compare to 10,000 ayear earlier.

Industrial Nursing

Preventative and sick benefits with visits. Lowered employee absenteeism.

Community

A group of individuals who share common interests or geographic.

Types of Community

• Geographic: most common type

• Common interest

• Communities of solution

Geographic Community

Any community that is defined by its geographic border. Data is easier to locate. Clear target for analysis of health needs. Allows community members to mobilize and carry out an intervention and prevention efforts can address specific needs. Helps in gaining the support of politically powerful people and resources in the community.

Geographic Community Examples

Families, schools, hospitals, churches, stores, and government institution

Community of Common Interest

They have a common interest or goal that binds the members together. Can be broad or specific.

Community of Common Interest Examples

National League of Nursing (NLN) and support groups

Community of Solution

One of the most encountered in community/public health. They come together to solve a problem that affects them all.

Community of Solution Examples

Water pollution

Population

Refers to all people occupying an area or to all those who share one or more characteristics. Made up of people who do not necessarily interact with on\e another but share a sense of belonging Different from community.

Aggregate

Refers to a mass grouping of distinct people who are considered as a whole and who are loosely associated with one another. “Subgroups”. Both in communities and populations.

Aggregates Examples

Older adults, children, people with diabetes, individuals with IDD, veterans, pregnant women, homeless, rural families, spanish-speaking communities

Difference between Community, Population, and Public Health

• Community Health: Health promotion in specific geographic area

• Population Health: Focuses on needs of a specific group. (disease prevention)

• Public Health: Health promotion and disease prevention. Tied to data and research.

Community Health

Focuses on the health and well-being of people within a specific community.

Goal: Improve the health and quality of life for the community

Population Health

Focuses on the health outcomes of a defined group of people (population).

Goal: Improve health outcomes and reduce disparities across populations

Public Health

Focuses on the organized efforts of society to prevent disease, promote health, and protect the health of all people.

Goal: Create conditions where everyone can be as healthy as possible.

Community Health Nursing

Goal: Decrease health inequities

• Addresses social determinants of health

• Focus is usually on family unit.

• Practice settings: Schools, workplace, churches, correctional facilities, home health

Population Health Nursing

Targets groups are those with or “at-risk” for specific health conditions

• Assist clients in managing health conditions in community

• Connect clients to community resources

• Coordinate care across health care spectrum

• Create health initiatives that target specific population

• Goal: Overall improvement in quality of life

Population Health Practice/Key Principles of Public Health

Works to achieve the greatest good for the largest number of individuals

Scope - Broad, encompasses an entire culture or population. Focuses on specific public health issues

Focus - Health outcomes and disparities among populations. Protection and improvement of community health.

Approach - Data driven, policy making, addressing SDOH. Organized efforts, health education, disease prevention.

Strategies - Policy changes, healthcare system improvements. Public health campaigns, vaccine programs

Examples - Reducing health disparities across the country. National immunization programs

Trends in Public Health Nursing

Technology

• Public health informatics (PHI) integration: Allows providers to have access to health, social, and environmental data in a consolidated manner

• Telemedicine: Concern about erosion of the relationship between clients and providers.

Aging

• More chronic illnesses

• Increased health care spending

• Shortage of providers

• Quality of life ethical issues

3 Core Functions of Public Health

• Assess: Monitor health and identify community needs and problems

• Policy development: Develop policies and plans that support healthy communities

• Assurance: Ensure that services are available, accessible, and effective for all

Assessment

• Gathering/analyzing health data

• Examples: epidemiological statistics

Policy Development

• Collaboration with lawmakers

• Development of public health policies

Assurance

Improve accessibility and delivery of services

10 Essentials of Public Health

1. Monitor Health

2. Diagnose and Investigate

3. Inform, Educate, Empower

4. Mobilize Community Partnerships

5. Develop Policies

6. Enforce Laws

7. Link to Services

8. Assure Competent Workforce

9. Evaluate

10. Research (can be in any order)

Workforce Shortage

• Baby Boomer retirements

• Increased need for population health nurses

• Decrease after COVID

Medicalization

• Increased use of pharmaceuticals (which means decrease in prevention)

• Takes focus away from preventative lifestyle changes

Focus on Populations

• Health care should address social determinants of health

• Sochalski and Weiner 2011

Florence Nightingale

“Health is not only to be well but to use well the powers we have”

Health

• Refers to a person’s physical, mental, and spiritual state. Can be positive or negative

• A holistic state of well-being which includes soundness of mind, body, and spirit

Ask what health means to community.

Wellness

Encompasses a proactive approach to living, focusing on balance, personal growth, and holistic health. Shaped by culture and western medicine believes that health and wellness cannot coexist.

Health Continuum

Always changing and always moving. Healthiness involves a range of degrees of health and illness. This is a state of constant flux improving or deteriorating.

Health Promotion vs Disease Prevention

Health Promotion: Empowers people to improve health and well-being. Focus: Building healthy habits and supportive environments to enhance quality of life. EHANCE and MAINTAIN well-being.

Disease Prevention: Prevents illness or detects it early to reduce its impact. Focus: Preventing disease, injury, and complications. PREVENT illness and REDUCE risks.

Health Promotion Examples

Healthy eating, physical activity, stress management, social connection, tobacco-free living, safe/supportive communities

Disease Prevention Examples

Vaccines, health screenings, injury prevention, infection control, risk factor reduction, early treatment

Frameworks for Community Health Nursing

• Ecological Model

• Health Belief Model

• Stages of Change (Transtheoretical) Model

• Social Cognitive Theory

Ecological Model

Shows how internal and external factors affect behavior and is helpful in looking at what determinants can positively or negatively affect health behaviors when developing health program.

A series of circles, each smaller circle is within the larger one. The largest circle is labeled public policy, which includes laws and polices by the government on any level. The next circle down is community-related, which includes social norms. Next is institutional, which includes rules and regulations of an organization. Next, interpersonal, which includes interactions with others. Finally, the smallest circle is internal, which includes beliefs.

Health Belief Model

• Purpose is to predict or explain health behaviors

• Assumes that preventive health actions are taken primarily for the purpose of avoiding disease

• EMPHASIZES change at the individual level. Describes the likelihood of taking an action to avoid disease based on: Perceived susceptibility, seriousness, and threat of disease, modifying factors, cues to actions, perceived benefits minus perceived barriers to taking action

Stages of Change (for Transtheoretical Model)

• Pre-contemplative (not seeing a need to change)

• Contemplative (see the need for change but blocked by barriers to adopt change)

• Preparation (creating a plan to change

• Action (implementing the plan to change)

• Maintenance (implementing and maintaining the plan for change

• Termination (the healthy behavior is ingrained without thoughts to engage in previous behavior)

Social Cognitive Theory

Provides opportunities for social support through instilling expectations, self-efficacy, and using observational learning and other reinforcements to achieve behavior change

Upstream Thinking

Focus on larger social issues

• Encouraged and seeks implement wide reaching, systemic change; this also addresses and potentially fixes things before problems develop

• Examples: Government funded health insurance, affordable housing

Downstream Thinking

Current problems, narrow focus

Pender’s Health Promotion Model

Internal motivation factors to adopt healthy lifestyles.

• Helps nurses understand factors that affect an individual’s health and guide them toward healthier behaviors.

Primary Prevention

• Goal: To keep illness or injury from occurring

• Almost always includes education

• Deals with public health

Primary Prevention Examples

• Nutrition education

• Family planning and sexual education

• Smoking cessation education

• Education regarding health hygiene

• Providing immunizations

• Advocating for access to health car, healthy environments

• PPE

Secondary Prevention

• Goal: Early detection and treatment of disease to limit the severity and adverse effects

• Always includes screening

• Where most patients are diagnosed with condition and where they usually start medications

Secondary Prevention Examples

• Community assessments

• Disease surveillance

• Screenings: Cancer, DM, HTN, hypercholesterolemia, sensory impairments, TB, lead exposure, genetic disorders, outbreaks of communicable diseases

Tertiary Prevention

• Goal: Reducing the limitations of disability and promoting rehabilitation following health alterations. Minimize complications and maximize health.

• “Try” to limit the effects

• Already have disease. Monitor taking medication.

Tertiary Prevention Examples

• Rehabilitation

• Nutrition counseling following Chron’s

• Case Management

• PT and OT

• Support groups

Social Drivers of Health

• Defined as the conditions in the environments where people are born, live, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

• External factors that influence health.

• The primary goal of recognizing social determinants of health is to improve the health status of individuals and populations through use of strategies such as public health planning, implementation, and evaluation

5 Categories of Social Drivers of Health

• Economic Stability

• Access to and quality of education

• Access to and quality of health care

• Neighborhood/built environment

• Social and community context

Economic Stability

• Rising unemployment rates

• Increased incidence of poverty

• Food insecurity (Food Desert and Food Swamp)

• Lack of access to transportation

Food Desert vs Food Swamp

• Food Desert: Lack of access to healthy food

• Food Swamp: More unhealthy than healthy food available

Strategies to Improve Economic Stability

• Job training programs

• Career counseling

• Affordable and quality childcare services

• Food stamp programs

• Convenient, affordable transportation options

Education Access and Quality

• Benefits of quality education: Chance to make a living wage, improved access to health care benefits, better decision-making about health, positive health outcomes, host preventative screenings

• Poor quality schools: violence and bullying, high student-to-teacher ratios, lack of school nurses, precipitates behavioral and mental health issues.

• School fundings comes from property taxes. Areas of poverty have less funding.

Strategies to Improve Education

• Adequate numbers of school nurses: Play an important role in assessment and connecting students with resources

• School-based mental health services

• Breaking cycle of poverty → Nurse-Family Partnership (NFP)

Health Care Access and Quality

• Lack of insurance coverage (or underinsured → co-pays too expensive)

• Rising health care costs

• Increased use of emergency departments as primary care

• COVID-19 pandemic highlights disparities: Marginalized populations had higher mortality rate

• Lack of primary care providers, especially in rural areas → lack in primary and secondary health interventions

• Lack of health literacy → Language barriers, “Noncompliance” may not be the issue

Costs of Health Care

• Costs continue to rise

• Provider shortage (especially primary care)

• Rising cost of medical education

• Lack of funding

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

• Required of any institution that receives federal funding

• Leading key indicator of health care quality

• Data obtained through surveys

• Reimbursement is based on survey data

Affordable Care Act (ACA)

• Insurance marketplace

• Greatly reduced number of uninsured

Medicare

Covers adults older than 65 years or younger than 65 years with disability

Medicaid

Insurance coverage for low-income individuals

Strategies to Improve Health Care Access

Affordable Care Act, Medicare, Medicaid, Telehealth (virtual health care), and Community health centers

Built Environment

Refers to a human-made environment that provides the setting for living, working, and playing and supporting infrastructures such as water supply and energy networks

• One-third of deaths from stroke, lung cancer, and heart disease are the result of exposure to air pollution

Neighborhood and Built Environement

• Violence

• Unsanitary water supply

• Air pollution

• Secondhand smoke

• Noise

• Failing infrastructure

• Occupational hazards

Social and Community Context

• Children who have incarcerated parents

• Dysfunctional family units

• Builting and violence

• STIs and adolescent pregnancy

Strategies to Improve Social Context

People function best and live longer with established ties to trusted groups of friends and family

• Promote positive family relationships

• Mentoring for adolescents (Boys and Girls Club of America)

• Programs to prevent STIs and pregnancy in adolescents (Healthy Teen Network)

• Support groups and counseling

Social Capital

The connections that strengthen individuals and communities

How Do the Social Determinants of Health (SDOH) Affect Community Health?

• Correlation between health status and socioeconomic factors (income, education, social status) → Lower socioeconomic status= worse health. Higher= Better health

• Global phenomenon

• Pertains to: Morbidity and mortality (infant mortality, life expectancy) and Behaviors (smoking)

Socioeconomic Gradient

The relationship between a person's socioeconomic status (such as income, education, occupation, and pay) and their health, where health outcomes generally improve as socioeconomic status increases.

People with lower socioeconomic status tend to have higher rates of illness and death, even when they have the same health insurance and access to care, due to factors like limited access to healthy food, safe housing, quality healthcare, and other social determinants of health.

Health Disparities

• Quantity of disease

• Burden of disease

• Age and rate of mortality due to disease

• Health behaviors and outcomes

• Other health conditions

• Access to health care

• Quality of health care

Avoidable, unfair, unjust

Health Literacy

• Essential to client autonomy and good client outcomes

• Includes using plain language, visual aids, and culturally relevant examples

Why is Health Literacy Important?

• Obtain access to relevant services and information

• Effectively communicate their personal needs and preferences

• Comprehend and interpret the available health information and services

• Understand the context, alternatives, and potential outcomes within healthcare environments

• Make informed decisions that correspond with their individual needs and preferences

Health Equity vs Health Equality

• Health Equity: Everyone is given different care to be on the same level

• Health Equality: Everyone is given same care but could end up on different levels

Healthy People 2030

Serves as a measure for quality of health and these goals guide the nurse in developing health promotion strategies to improve individual and community health

• Use the scientific data and trends collected during the prior decade

• US Dept of Health and Human Services publishes these goals every 10 yrs

• These goals are based on issues that are considered major health risks to the health and wellness of the US population

Healthy People 2030 Vision Statement

“A society where everyone has the opportunity to reach their full health and well-being potential.”

Healthy People 2030 Primary Focus Area

• Promoting health equity, reducing disparities, and enhancing health literacy, decrease tobacco use, tackle mental health challenges, increase vaccination coverage, reduce chronic disease rates (diabetes, heart disease)

• Tackling the social determinants of health

Goals of Healthy People 2030

1. Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death.

2. Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

3. Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.

4. Promote healthy development, healthy behaviors, and well-being across all life stages.

5. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.

Goal vs Objective

• Goal: The big picture. A broad statement of what we want to achieve.

• Objective: The specific steps. A clear, measurable action that helps us reach the goal

Roles of C/PH as Nurses

Researchers, Clinician, Educator, Advocate, Manager, Collaborator, Leadership

Educator

• Health teacher

• Community clients are not acutely ill

• Wide populations

Clinician

• Most familiar role (aka care provider)

• Three emphases: Holism (physical, emotional, social, spiritual, and economic as system), Health promotion, Skill expansion

Holism

The client is a composite of people who they have a relationship and interaction with must be considered in totality. (systems perspective)

Manager

• Helps achieve client's’ goals

• Planner, organizer, leader, controller/evaluator, management behavior, case management

Case Management

A systematic process that the nurse assesses clients needs, plans for and coordinates services, refers to other appropriate providers, and monitors and evaluates progress to ensure that clients multiple service needs are met in a cost-effective manner

Leadership

• Not management

• Agents of change

• Think Florence and Lillian

Researcher

• Systematic investigation, collection, and analysis of data for solving problems

• Seeking evidence-based solutions to addressing needs in community settings