population and public health nursing (module 2)

patient care focus on:

treatment of specific diseases and conditions

downstream symptoms of health problems

medical and biological determinants of sickness

patients

healthcare providers, purchasers and payers

population health focus on:

wellness, prevention, and health promotio

upstream causes of health problems

social determinants of health and community conditions

all people

partnerships between health and sections such as education, transportation, and housing

The emergence of “population health” as a significant component of healthcare reform reflects?

widespread recognition that factors outside of the healthcare

system, such as the social, economic and physical environment, must be addressed in order to improve the health of the overall population.

While there is growing agreement on the importance

of population health, there is a lack of consensus on a single, actionable definition of the term.

population health

The health outcomes of populations.

the distribution of health outcomes across a defined group*

groups are 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

Improving population health requires that?

healthcare providers and organizations look beyond their own systems and partner with other organizations, entities, and professionals.

what determines health?

20% genetics

20% healthcare

60% social, environmental, behavioral factors

social determinants of health

the economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole

Health is tied to the?

distribution of resources.

Health is more than health care.

The choices we make are shaped by?

the choices we have.

High demand + low control =

chronic stress

Chronic stress can be deadly (cortisol response)

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

Where you work, live, and play…

Impacts your health!!

Health 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 circumstance. 

Achieving health equity requires…

social justice, “the fair and compassionate distribution of the fruits of economic growth.”

Health disparity:

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

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

equality

the assumption is that everyone benefits from the same supports

this is equal treatment

equity

everyone gets the support they need

affirnative action

justice

the causes of the inequity was addressed

Public Health Nursing

• Focuses on entire populations. 

• Grounded in the assessment of the population’s health status

• Considers the broad determinants of health

• Focuses on all levels of prevention, with an emphasis on primary prevention.

• Collaborates with a variety of other professions and stakeholder groups.

public health nursing 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.

The client “unit of care” is the…

population

Achieve the greatest good for the greatest number

what are the priorities are PHN?

Health promotion and protection

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

• Actively reach out to all who might benefit

• Use available resources

• Collaborate with other professions and organizations

Health promotion

• Individual to population level

• Attaining optimal health

Risk reduction

Reduces person’s risk for disease

Health protection

Person’s ability to protect against disease

Legal Guidelines, Laws & 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, investigations, confidentiality)

criminal laws (prisons)

Minnesota PHN Intervention Wheel

• 3 levels of practice

  • Individual/Family

  • Community

  • Systems

• 17 public health interventions

Activities defined by 17 Public Health Interventions

• Surveillance

• Disease Investigation

• Outreach

• Case Finding

• Screening

• Delegated Function

• Referral/Follow-up

• Case Management

• Health Teaching

• Counseling

• Consultation

• Collaboration

• Coalition Building

• Community Organizing

• Advocacy

• Social Marketing

• Policy Development & Enforcement

PHN 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

PHN 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

1. assessment

2. policy development

3. assurance

Assessment

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

Policy Development

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

Assurance

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

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 - 1850’s

• Daughter of wealthy English landowner

• 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

  • Demonstrated need for reform

florence nightingale 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

Massachusetts 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

The Nursing Process

• Assessment

• Nursing Diagnosis

• Planning

• Implementation/Intervention

• Evaluation

Community Assessment

• 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

The residents of the community are affected by and influenced by eight subsystems of the community. These include:

• 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