week 1 + 2: population and public health nursing + community health assessment

population health

the health outcomes of population

the distribution of health outcomes across a defined group

groups

often geographic populations such as nations, states, or neighborhoods but can also be other groups such as employees ethnic groups, disabled persons, prisoners, or any other defined group

ex. people is NYS, faculty at BU (employees)

improving population health

__ requires that healthcare providers and organizations look beyond their own systems and partners with other organizations, entities, and professionals

ex. need to look at education, transportation, political systems to improve population health

levels of healthcare practice

individual or family level → population (aggregate level) → community level

what determines health

genetics - 20%

(access to) healthcare - 20%

social, environmental, behavioral factors - 60%

social determinants of health

Education: Is there preschool education available in the neighborhood?

Healthcare and Quality
Is there access to insurance, hospital, urgent care?

Neighborhood and Built Environment
What is the neighborhood like?
Is it safe?

Social + Community Context
Is there a feeling of community?
Are there support/services?

Economic Stability
What is the money situation? job security

a few considerations

• Health is more than health care 

• Health is tied to the distribution of resources (more resources = better health)

• The choices we make are shaped by the choices we have

• High demand+low control =chronic stress 

• Chronic stress can be deadly (excess cortisol response)

chronic stress and the HPA axis (hypothalamic pituitary adrenal axis)

constant stress results in increased levels of cortisol → results in increased HR, BP, glucose intolerance, inflammation

factors that determine magnitude of the HPA axis response

novelty to the individual

unpredictable nature

perceived threat to the person

sense of loss of control

telomere shortening

(research from 2012) chronic stress can result in genetic changes

women who have been abused/formerly abused → results in genetic changes; the telomeres (genetic material) are shorted d/t the chronic stress and Hx of abuse

what impacts your health

where you work, live, and play

healthy equity

• When all people have the opportunity to ‘attain their full health potential’ and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstances. 

• Achieving ___ requires social justice, “the fair and compassionate distribution of the fruits of economic growth” 

• Everyone gets the support they need - takes into account what people do and do not have; people get what they need to end up being treated the same; not being given the same thing

how to improve health equity

• we must address the root causes of disparities. This means going beyond asking who is at greater risk for disease, to asking why some populations are at greater risk. 

healthy equality

• The assumption is that everyone benefits from the same support. This is equal treatment. 

• Everyone gets the same thing (10 oranges) - everyone is in the same place to receive it

healthy disparity

A particular type of health difference that is closely linked with social or economic disadvantage.

healthy justice

• All 3 can see the game without support or accommodations because the cause of the inequity was addressed. The systemic barrier has been removed. 

• Takes away the barrier

determinants of health: tracing back the “why”

public health nursing

“__ is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences” - APHA PHN Section

ex. during the covid pandemic

public health nursing → a population based practice

• Focuses on entire populations 

• Grounded in the assessment of the population’s health status (Data + Facts)

• Considers the broad determinants of health (SDOH: Economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, social & community context)

• Focuses on all levels of prevention (primary/secondary/tertiary), with an emphasis on primary prevention 

• Intervenes at multiple levels: 

  • The level of communities 

  • The systems that impact the health of communities and/or 

  • The individuals and families that comprise communities when the overall goal of the intervention is improving population health status, 

• Collaborates with a variety of other professions and stakeholder groups

principles of public health nursing

• The client “unit of care” is the population 

  • an individual may not like what public health is saying, but public health is doing what is best for the population

  • ex. during COVID, lots of people did not want to wear a mask (can make the individual upset), BUT public health nursing is looking at the population and mask wearing is good for the overall group 

• Achieve the greatest good for the greatest number 

• Health promotion and protection are the priorities 

• Select strategies that create healthy environmental, social and economic conditions 

• Actively reach out to all who might benefit 

• Use available resources - allocating resources to specific areas of need

• Collaborate with other professions and organizations - collaboration

essential components of nursing practice

health promotion

• individual to population level

• attaining optimal health

risk reduction

• reduced persons’s risk for disease

health protection

• person’s ability to protect against disease

legal guidelines, law&ethics supporting PHN practice State nurse practice acts, 

• Education, license, certification

• Standards of practice 

• Code of ethics 

• Public health laws (mandatory reporting) 

• Civil laws (surveillance, investigation, confidentiality) 

• Criminal laws (prisons)

Minnesota PHN intervention wheel

3 levels of practice

• individual/family

• community

• systems

17 public health interventions

public health nurses are

• Generalists (covers all areas of public health) AND/OR

• Specialists (some examples listed )

  • Communicable disease

  • Vaccine Preventable Disease

  • Homelessness & Social Medicine

  • Environmental health

  • Maternal-Child health

  • Emergency Preparedness

  • Health Screening

  • Public Health Education

  • Public Health Liaison

public health nurses work

• Local and State Health Departments

• Homes

• Schools

• Prisons

• Factories/Large Employment Firms

• Parishes, Churches, Synagogues, Mosques,

• Child Care Facilities

• Non-profit Relief Organizations (i.e., Red Cross)

• Nail Salons, Barber Shops

core public health functions

assessment

policy development

assurance

assessment (public health functions)

• Systematic data collection on the population, monitoring the population’s health status, and making information available about the health of the community

  • monitor health 

  • diagnose and investigate

policy development (public health functions)

• Efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions.

  • Inform, educate, empower 

  • Mobilize community partnerships 

  • Develop policies 

  • ex. individuals do not like wear seatbelts; having a law increases usage of seatbelts and as a public health POV decreases deaths from motor vehicle accidents

assurance (public health functions)

Making sure the essential community oriented health services are available.  Making sure that a competent public health workforce is available.

public health does not require rote memorization

The technical pieces of public health (biology of disease, economics of development, measurement of disease burden) are important but they are not overly complex

The complexity comes in asking new questions or old question in new ways – thinking about the world and our relationship to health in ways that we are not used to

This is why public health might seem a straightforward discipline (how hard is it to wash your hands?) but the challenge comes in the application

local and state public health departments

• Protect the health of citizens

• Surveillance 

• Outbreak investigation 

• Quarantine

• Mandated reporting of specific diseases

• Report cause of death to state health departments and the Centers for Disease Control and  Prevention

• Disaster preparedness

  • Natural 

  • Manmade 

• Oversee public sanitation 

• Safety of the water supply 

• Laboratory testing of water samples

• Inspection of sewer systems

• Health-related mandates

• Food safety

• Provide direct health care

  • Vaccines

  • Well-baby checks

  • Prenatal care

florence nightingale 1850s

• First public health nurse. How the environment impacted the health of soldiers

• Devoted life to prevention of needless illness and death

  • Prevention of infections

  • Focus on environmental health

• Reformer of hospital care

• Founder of professional nursing

  • First school opened 1860

• Pioneer in use of statistics & policy

  • Population based approach – Crimean War

    • Keeping track of death and disease 

  • Demonstrated need for reform 

  • Soldiers weren’t dying from wounds in battles. They were dying from disease that were preventable 

• Used statistics to show that hospital conditions during the Crimean War were deplorable 

  • Her studies led to: Political attention → more funding for the Army’s hospitals; improved cleanliness, hygiene, and nutrition 

  • Death rate of soldiers fell 

lillian wald

• 1885 Started the NYC Henry Street Settlement 

  • Later became the VNA of NYC

• Believed nurse should not only care for the sick in their homes but teach prevention, address social conditions

• Coined term Public Health Nursing

• Introduced “school nursing” in US

• Convinced Red Cross to work with rural communities

masaachusetts and the lemuel shattuck report

• Monumental 1850 report that established permanent boards of health in Massachusetts 

• Began collecting and recording vital statistics and promoted sanitary measures to prevent disease 

• Movement spread to other localities 

  • SC State Board of Health created in 1898

mary breckenridge

Established the Frontier Nursing Service in 1925 to provide nursing for underserved populations in remote mountains of Kentucky

nursing process

assessment → nursing diagnosis → planning → implementation/intervention → evaluation

community assessment model

• A process to…“getting to know the community”

• Logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources. 

• To gather data (primary and secondary)

  • Primary: key informant interviews, windshield survey, focus groups

  • Secondary: vital statistics, socio-demographic, health indicator surveys

• To analyze data collected and draw some conclusions

  • Determine actual or potential needs

  • Identify strengths, resources and barriers to meeting needs

the core of the assessment wheel → affected by 8 subsystems

• Physical environment

• Education

• Safety and transportation

• Politics and government

• Health and social services

• Communication

• Economics

• Recreation

community health assessment: interpreting indicators

• Compare benchmark rates, from sources such as HP 2030 targets, to local, state, and national rates 

• Consider the demographic and socioeconomic comparability of the populations from which the comparison rates are derived

• Examine both recent data and trend data

helps to guide

program planning

implementing intervention

evaluation

community WHO definitoin

a group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationship with the community

community (most common definition)

community of place or geographic boundaries; a cluster of people that share at least one common characteristics

has developed over time and members of a community gain their personal and social identity by sharing common beliefs, values and norms which happened to be developed by the community in the past and may be modified in the future

binghamton university community

subsystems: police, transportation, faculty, BU students, food services, health services, library staff

all these subsystems interact to function and have productive outcome

community health

meeting of collective needs by identifying problems and managing interactions within the community itself and between the community and the larger society

true measure of health

is going to be morbidity and mortality rate

more specifically, death rates

• if someone dies, we ask why did they die

gov uses morbidity and mortality to determine health of the community

consider a community with poor health outcome

shorter lifespan, higher prevalence of disease, and affects productivity of community

what does a healthy community look like to you

low crime rate

quality schools

supportive family life

robust economy, low unemployment and average income rate

high environmental quality (clean air, water)

accessible and quality health services

civic involvement

healthy people 2030 goals

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

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

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

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

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.

community health assessment

It is a logical, systematic approach to identify community needs, clarify problems, and identify community strengths and resources.

community health nursing goal

gain health equity = make preventions

describe the needs and develop strategies to address the needs

act of being acquainted with a community

identify where better information is needed

health disparities among various subpopulations and QOL to achieve health equity

• as a community health nurse, you want to know how the community health affects individuals and the larger population

motivation to complete community health assessment

are required by law, drives funding for public health activities and programs; allows allocation of limited resources and mandated for each county to complete every 3-4 years, part of ACA- affordable care act + mandated by non profit hospitals

principal challenge for nurses performing community health assessment

gaining entry and acceptance into a community

TRUST FROM COMMUNITY

sometimes the community can treat nurses as outsiders