public health

SCOPE OF PUBLIC HEALTH

Reference

  • DeMarco, R. F. & Healey-Walsh, J. (2020). Community and public health nursing: evidence for practice. (3rd Edition). Philadelphia: Wolters Kluwer

  • Rector, C. & Stanley, M. J. (2022). Community and public health nursing: Promoting the public's health. (10th Edition). Philadelphia: Wolters Kluwer

  • Caron, R. M. (2022). Population health, epidemiology, and public health: Management skills for creating healthy communities. (2nd Edition). Chicago, Illinois: Health Administration Press

  • American Nurses Association (2013). Public Health Nursing: Scope and Standards of Practice. 2nd Edition. Silver Spring, MD

Introduction

  • Public health nursing (PH nursing): Focuses on the health of all people/populations within communities to achieve social betterment.

  • Social betterment: Originally described by Lillian Wald in 1912, it involves understanding upstream determinants of health where individuals engage in daily life.

  • Public health nurses (PHNs): Aim to ensure health equity and well-being by preventing and reducing health disparities.

Key Aspects of PH Nursing Practice

  • Population-based: Focuses on care across various levels including individuals, families, small groups, communities, and systems, while considering the community context.

  • Contribution to public health: For over a century, PH nursing interlinks nursing knowledge with public health expertise to enhance community health.

  • Partnerships: PHNs cultivate effective partnerships to address health conditions and their determinants.

History of Public Health Nursing in Ghana

  • 1920: Initial appointments of female sanitary inspectors alongside male counterparts.

  • 1921: Health visitors like Mrs. Anne Blankson and Mrs. Emma Barnes are appointed.

  • 1923: Appointment of Dr. Mc Grill, the first school health doctor, and establishment of child welfare clinics.

  • 1926: Cadbury and Fry Company train health visitors who assist in home visiting alongside health inspectors.

  • 1926: New hospitals open in Accra for pregnant women and sick children, leading to trained Sick Children’s Nurses who conduct home visits.

  • 1950: Shift of Health Visitors from PML to the Medical Officer of Health's Department and introduction of British health visitor Miss Dorothy Pittock to Ghana.

  • 1952: Establishment of the first Public Health Nurses School in Ghana, following a British syllabus, producing trained professional health visitors.

  • 1958: Relocation of the school to the Nurses Training College at Korle-Bu for continuity in medical education.

  • 1966: Upgrading courses at the institution, eliminating the recruitment of certain nursing qualifications.

  • 1969: Introduction of a three-month orientation course for newly qualified Senior Registered Nurses (SRNs) joining the Public Health sector.

  • Present: The course has now evolved into a degree program, retaining a focus on various health aspects, including child health and occupational health.

Definitions

  • Public Health: The science and art of preventing disease, prolonging life, and promoting health through organized efforts, as defined by Winslow in 1920.

  • Public Health Nursing (PH Nursing): The practice of promoting and protecting the health of populations using knowledge from nursing and public health science, focusing on prevention and control of diseases rather than solely rehabilitation (American Public Health Association, 2013).

Focus Areas of PH Nursing

  • Determinants of health: PH nursing assesses social, physical, environmental determinants impacting health outcomes.

  • Prevention levels: Emphasizing primary prevention, such as education and engagement in healthy practices.

  • Scope of work: Encompasses activities such as assessment, planning, policy development, and collaboration with stakeholders.

Core Concepts Guiding Public Health Nursing Practice

1. Social Determinants of Health

  • The World Health Organization (WHO) defines social determinants of health as conditions in which people are born, grow, live, work, and age, significantly shaping health outcomes.

  • Five core categories include:

    • Genetics

    • Individual behavior

    • Physical environment

    • Social environment

    • Healthcare services

  • PHNs address these determinants to enhance health equity and social justice, identifying community-level factors that influence health outcomes.

Interconnectedness of Factors

  • Key areas impacting health include environmental factors, structural racism, economic status, and social support structures.

2. Community Collaboration

  • Collaboration is essential for ethical public health practice, involving community stakeholders in identifying health needs and developing strategies to address those.

3. Population Health

  • Defined as the health outcomes of a group, including distribution within the group and encompassing social, cultural, and environmental conditions that shape these outcomes (ANA, 1986).

Community Definitions

  • A community may be a geographically defined area or a group with shared characteristics, such as students in a school or members of a specific demographic.

4. Ecological Model of Health

  • PHNs operate across micro to macro levels, including:

    • Micro-level: Individual health and direct services (primary, secondary, tertiary prevention).

    • Meso-level: Community-focused interventions targeting specific groups.

    • Macro-level: Evaluating broader policies and societal factors affecting community health.

5. Culturally Congruent Practice

  • Emphasizes the importance of culturally competent care that respects diverse values and practices, integrating cultural factors into health promotion strategies.

6. Levels of Prevention in Public Health Nursing

  • Employ all prevention levels:

    • Primary Prevention: Prevents disease before it occurs (e.g., health education, immunizations).

    • Secondary Prevention: Early detection through screening (e.g., mammograms).

    • Tertiary Prevention: Reduces impact of existing illness through treatment and rehabilitation.

7. Ethics in Public Health Nursing

  • Ethical principles guide PH nursing practice, focusing on population health and obligations toward communities and vulnerable groups.

8. Social Justice in Public Health

  • Social justice principles aim to correct structural inequities that disadvantage certain populations, emphasizing a moral commitment to health equity.

9. Health Equity

  • Defined by WHO as the absence of avoidable disparities in health outcomes among groups defined by social or economic disparities.

  • Achieved when every individual has a fair chance to attain full health potential, demanding actions to eliminate obstacles to health like discrimination and poverty.

Core Functions of Public Health

Core Functions of Public Health Include:

  • Assessment: Identifying community needs and monitoring health trends, using qualitative and quantitative data.

  • Policy Development: Formulating policies based on community assessment results and prioritizing health needs, with effective evidence-based strategies.

  • Assurance: Encompasses regulation, advocacy for services, and provision of direct services when necessary.

Principles of Public Health Nursing Practice

  • Focuses on comprehensive population health assessments, commitment to equity and preventive strategies, community partnership, and resource optimization for health improvements.

The 10 Essential Public Health Services

  • Developed by the CDC, these services provide a framework for public health activities:

    1. Assess and monitor community health status.

    2. Investigate and address health hazards.

    3. Communicate health policies and information effectively.

    4. Mobilize community partnerships to improve health.

    5. Implement policies that impact health outcomes.

    6. Utilize legal actions to protect public health.

    7. Ensure equitable access to health services.

    8. Build a diverse and capable public health workforce.

    9. Innovate through evaluation and research for quality improvement.

    10. Maintain a strong organizational infrastructure for health services delivery.

Core Competencies of Public Health Nursing

  • Includes assessment, policy development, community partnership skills, communication, cultural competency, and leadership capabilities crucial for effective public health practice.

Roles of Public Health Nurses

Clinician:

  • Provides health services to individuals and communities with a focus on holistic care, health promotion, and prevention.

Educator:

  • Focuses on dissemination of health information to enhance public health understanding and promote healthy behaviors.

Advocate:

  • Acts on behalf of clients to secure necessary health resources and navigate health systems, particularly for marginalized populations.

Manager:

  • Oversees care delivery processes encompassing assessment, planning, directing, and evaluation to achieve health goals.

Collaborator:

  • Works with multidisciplinary health teams to enhance care through shared outcomes and coordinated efforts within community contexts.

Leadership:

  • Initiates and advocates for health changes, influences public health policy, and engages in strategic health planning.

Researcher:

  • Engages in data collection and analysis to improve public health practices and inform policy-making.

Settings for Community and Public Health Nursing Practice

Common Settings Include:

  • Homes: Wholesome context for public health nursing roles to be applied, such as post-discharge care.

  • Ambulatory/Outreach Services: Including public health departments, clinics, and community health centers.

  • Schools: Critical environments for public health nursing to monitor student health and provide education.

  • Occupational Health: Promotion of employee health within organizations.

  • Residential Institutions: Environments such as halfway houses or hospices that require specialized nursing services and care.