MODULE 1: foundations of public health nursing + health policy, politics, and reform

health equity

The principle that everyone should have a fair and just opportunity to reach their full health potential.

- rooted in a commitment to social justice

- "where everyone has the opportunity to be as healthy as possible"

equality

the assumption is that everyone benefits from the same supports

- this is equal treatment

equity

individuals are given different supports to make it possible for them to have equal access

justice

everyone gets what they need without supports or accommodations because the causes of the inequity were addressed

- systemic barrier has been addressed

human right; privilege

Health equity is rooted in the belief that health is a ________________ and not a ______________.

health inequities

differences in health outcomes for marginalized populations that are unfair and avoidable

true: these measures included burying wastes away from sewage supply, sewage systems, healing herbs, delivering babies, and use of hot/cold

true or false: History indicates that early societies engaged in public health measures

Mary Breckinridge

Established the Frontier Nursing Service (1925)

- traveled on horseback to study the health needs of the mountain people

- realized that children's healthcare must begin before birth with the care of the mother and continue throughout childhood, while including care for the entire family

Mary Robinson

first district nurse in England, hired by William Rathbone

Florence Nightingale

Founder of modern nursing

- documented her successes in saving lives through improving environmental conditions and thus preventing infections during the Crimean War

- led to significant changes in hygienic practices and sanitation methods both during the Crimean War and subsequently in England

Lemual Shattuck

prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions

The Shattuck report

provided for the first systematic use of birth and death records and demographic data to describe the health of a population

- became the foundation of the sanitation movement in the United States

Dorothea Dix

an American political activist in the 19th century who became aware of the dreadful conditions in prisons and mental hospitals, and she vigorously lobbied state and federal officials to remedy the situation

Clara Barton

- a nurse leader, achieved widespread recognition during the Civil War, distributing supplies to wounded soldiers and caring for the casualties with the help of her team of nurses.

- recognized the need for a neutral relief society in the United States that could be activated in times of war

- founded the American Red Cross

Lillian Wald

"founder of public health nursing"

- founded the Henry Street Settlement

- provided a blueprint that endures: treat everyone with dignity, respect, and care

- labor activist

- co-founder of NAACP even when she could not vote

- organized places for children to play

- brought reform to public schools

Henry Street Settlement House

- first public health house

- founded by Lillian Wald

- within a decade, included a team of 20 nurses and social workers who worked together to address not only the medical needs but also the social needs that impacted the health of the poor

- astonishing array of innovative and effective services

preventable chronic diseases

The U.S. struggles with escalating costs and increasing morbidity and mortality from _______________________________ that continue to plague the healthcare system.

illness care system

With its emphasis on episodic treatment of diseases rather than prevention and health promotion, the U.S. system has been referred to as an "_______________________" rather than a healthcare system.

true

true or false: A recent study shows that although the United States spends more money on healthcare than any of the other 10 high-income countries included, in comparison, the United States has a shorter life expectancy and ranks lowest in performance among key health indicators, including access to care, administrative efficiency, healthcare outcomes, and health equity

1. biomedical model

2. focus on fee for service, episodic treatment

3. emphasizes costly high-technology interventions and specialized acute and emergency care

focus of the clinical care services side of the U.S. healthcare system (3)

1. cost-effective illness prevention

2. health promotion at population and community levels

focus of the public health services sector of the U.S. healthcare system (2)

social determinants of health (SDOH)

conditions (nonmedical factors) that impact the extent a client or population resources to attain and maintain healthcare

- living conditions

- incomes

- educational background

1. economic stability

2. education access and quality

3. healthcare access and quality

4. neighborhood and built environment

5. social and community context

5 domains of SDOH

social justice (health viewed as basic right for all, not a privilege)

public health is founded on this principle

the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

WHO definition of health

public health

the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals

promote and protect the health of all people in all the communities where they live, learn, work, and play

public health seeks to...

1. assessment

2. policy development

3. assurance

3 core functions of public health

assessment

involves investigative and surveillance strategies to continually monitor the health of populations while identifying and responding to the causative factors of health hazards

policy development

seeks to maximize intersectoral collaboration through the shared development, implementation, and evaluation of laws, policies, and plans, using legal and regulatory processes as needed

assurance

relates to:

- the adequacy of the organizational infrastructure

- diverse and effective personnel

- quality improvement efforts through ongoing research and innovation

- the identification and removal of barriers that block equitable access for all populations

CDC

assumes an essential leadership role in public health in the US and globally

population health

- Health outcome of a group of individuals

- Outcome-driven approach to manage health for a specific group of individuals, typically defined by attribution

community health

- Tends to be geographically based

- Rooted in collective efforts of individuals and organizations who work to promote health within a geographically or culturally defined group

health disparities

Differences in healthcare and health outcomes experienced by one population compared with another

1. cost of care

2. quality of care

3. access to care

major policy concerns when it comes to health equity (3)

incrementalism

Most changes in health policy occur as small iterative changes to existing policy; this is known as ______________________.

1. Direct caregivers

2. Awareness of patient safety and satisfaction, access to services, clinical outcomes, and health disparities

3. Positioned to see impact of policy on individuals

Why is nurse-informed political involvement important? (3)

1. Focus on the aggregate

2. Promote prevention

3. Encourage community organization

4. Practice the ethical theory of the greater good

5. Model leadership in health

6. Use epidemiologic knowledge and methods

characteristics of public health nursing (6)

1. Early childhood care and education

2. Unstable housing

3. Wealth and income disparities

4. Discriminatory practices

5. Structural racism

What domains are important to address by nurses to promote health equity? (5)

advocacy, policy development, and planning, which addresses issues of social justice and underscores a commitment to health equity

The American Public Health Association (APHA) Public Health Nursing Section defines public health nursing as a practice that includes...

true

True or false: The ANA code of ethics describes the responsibilities of nurses to advocate for the health of the public.

1. integrate legal and policy guidelines and ethical and social justice principles into their nursing practice

2. collaborate with public, other health professionals, legislators, policy leaders, and community decision makers to protect human rights, promote equity, and reduce health disparities

- emphasis on role in advocacy, policy, promoting health equity, and caring for underserved populations

The Scope and Standards of Public Health Nursing Practice outlines PHN's major responsibilities (2)

stakeholders

individuals, an organization, or a group that has an interest (stake) in a specific community health issue, or the outcome of a community health intervention—who would be interested in supporting later school start times, like local pediatricians, parents of exhausted high school students, and teachers

lobbyists

Professionals who work to influence policymakers

- have a deep working knowledge of the legislators, the policy process, and the timeline for policy decisions