Scope of Public Health Nursing

SCOPE OF PUBLIC HEALTH

Presenter Information

  • Presenter: Diana Hans Wilson (Mrs)

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

  • Definition of Public Health Nursing: Public Health Nursing (PH nursing) focuses on the health of populations within communities to achieve social betterment.

  • Concept of Social Betterment: A term first used by Lillian Wald in 1912, describing the goal of PH nursing, which considers upstream determinants of health related to where people live, work, learn, play, and worship.

  • Objective: Public health nurses (PHNs) strive to ensure health equity and improve well-being by addressing and reducing health disparities.

PRACTICE IN PUBLIC HEALTH NURSING

  • Population-Based Approach: PH nursing practice focuses on multiple levels of care, including individuals, families, small groups, and communities, always maintaining a community context.

  • History of Contribution: Over a century, PH nursing has significantly improved population health, merging nursing skills with public health expertise.

  • Partnerships: PHNs work collaboratively to address health determinants and improve outcomes.

ROLE OF PUBLIC HEALTH NURSES

  • Leadership: PHNs possess leadership capabilities to advance community health initiatives, advocating and developing policies to reduce health inequities.

  • Cultural Change: Focus on creating a culture of health through enhancing the health of individuals, families, and communities.

HISTORY OF PUBLIC HEALTH NURSING IN GHANA

Early Developments

  • 1920: Appointment of female sanitary inspectors alongside male inspectors to visit homes.

  • 1921: Appointment of health visitors such as Mrs. Anne Blankson and Mrs. Emma Barnes.

  • 1923: Establishment of the first school health doctor, Dr. Mc Grill, and initiation of child welfare clinics in various parts of Accra.

  • 1926: Recruitment and training of workers as health visitors and opening of hospitals like the Maternity Hospital and Princes Marie Louise Hospital.

Nurse Training and Expansion

  • Home Visiting: Trained nurses visited homes to advise on child care at the Princes Marie Louise Hospital.

  • 1940s Developments: Movement of health visitors to the Medical Officer of Health’s Department and the introduction of a British health visitor to train professional health visitors.

  • Public Health Nursing School: Established in 1952, with curriculum including hygiene, communicable diseases, nutrition, and maternal-child health.

Education Progression

  • Course Upgrade (1966): Registered Nurses were no longer admitted. A new orientation program for newly qualified nurses was introduced to adapt them to public health nursing.

  • International Students: Admission of students from countries like the Gambia, Liberia, and others.

  • Current Status: Upgraded public health nursing courses leading to degree programs.

DEFINITIONS IN PUBLIC HEALTH

Public Health

  • Definition: According to Winslow (1920), public health is the art and science of preventing disease, prolonging life, and promoting health through organized community efforts for sanitation, control of infections, medical service organization, and ensuring adequate living standards (Winslow 1920, 30).

Public Health Nursing

  • Definition: Described by the American Public Health Association (2013), public health nursing is the practice of promoting and protecting population health using knowledge from nursing, social, and public health sciences.

  • Core Focus: Not only providing care but also emphasizing prevention and addressing communicable diseases.

KEY FEATURES OF PUBLIC HEALTH NURSING

  • Levels of Prevention: Emphasizes primary prevention while using all prevention levels (primary, secondary, tertiary).

  • Focus Areas: Addresses the social, environmental, and physical determinants of health, including assessment, program planning, evaluation, advocacy, and collaboration.

CORE CONCEPTS IN PUBLIC HEALTH NURSING PRACTICE

1. Social Determinants of Health

  • WHO Definition: Conditions in which people are born, grow, live, work, and age impact health. Influenced by genetics, behavior, environmental factors, medical care, and social factors.

  • Key Categories: Includes individual behavior, physical environment, social environment, and healthcare access.

2. Community Collaboration

  • Importance of Collaboration: Engaging community members in identifying health priorities and developing interventions is crucial for ethical public health practice. Community participatory approaches enhance health strategies.

3. Population Health

  • Definition of Population: Defined as a collection of individuals in a defined area or shared characteristics within a community (ANA, 1986).

  • Population Health Outcome: Addresses health outcomes across social, cultural, environmental, and physical conditions affecting communities over time.

4. Ecological Model of Health

  • Continuum of Care: PHNs operate across micro, meso, and macro levels addressing different factors impacting health collectively.

5. Culturally Congruent Practice

  • Definition: Incorporating community and consumer cultural values, beliefs, and practices into health care delivery.

  • Cultural Competence: Ability to provide culturally appropriate services and effective communication in diverse settings.

6. Levels of Prevention in PH Nursing

  • Types of Prevention: Emphasis on primary prevention through community education, immunization, and health promotion strategies. Secondary prevention includes screening, and tertiary prevention focuses on rehabilitation and support for chronic conditions.

ETHICS AND SOCIAL JUSTICE IN PUBLIC HEALTH

Ethical Considerations

  • Core Ethics: Emphasizing the moral responsibility to maintain health equity, social justice, and environmental justice.

  • PH nursing goals: Focus on broadening health access while addressing social structures leading to inequities.

7. Health Equity

  • WHO Definition: Health equity means fair opportunities to attain health potential without social, economic, or demographic disadvantages.

  • Key Aspects: Efforts directed at marginalized groups aim to reduce disparities and improve overall community health.

CORE FUNCTIONS OF PUBLIC HEALTH

  1. Assessment: Continuous gathering of community health data to anticipate needs and risks.

  2. Policy Development: Use evidence and community data to inform and influence health policies and regulations.

  3. Assurance: Ensuring health service quality, availability, and access.

PRINCIPLES OF PUBLIC HEALTH NURSING PRACTICE

  1. Population Focus: Systematic assessment and health promotion with a focus on community needs and overall well-being.

  2. Equity: Central to PH nursing goals, ensuring health fairness.

  3. Collaboration: Engagement with communities as equals in decision-making.

  4. Utilization of Resources: Efficient use of available resources and creation of evidence-based strategies to enhance community health.

ESSENTIAL PUBLIC HEALTH SERVICES

  • Assessment and Monitoring: Evaluate factors influencing community health.

  • Investigate and Address Health Issues: Identify and resolve community health hazards and issues.

  • Effective Communication: Educate the public on health matters and policies.

ROLES OF PUBLIC HEALTH NURSES

1. Clinician Role

  • Provides health services to individuals, families, and population units within a broader context of care.

2. Educator Role

  • Focuses on health promotion and education to empower communities and educate about health risks.

3. Advocate Role

  • Protects clients' rights, ensuring access to the services they require, especially for vulnerable populations.

4. Manager Role

  • Assesses community needs and organizes services to achieve client health goals.

5. Collaborator Role

  • Works collaboratively in multidisciplinary teams to enhance community health outcomes.

6. Leadership Role

  • Initiates health planning, coordination, and advocacy for health policies influencing community health.

7. Researcher Role

  • Engages in data collection and analysis for enhancing public health practices through evidence-based inquiry.

SETTINGS FOR COMMUNITY AND PUBLIC HEALTH NURSING PRACTICE

Home Care

  • Primary setting for public health nursing, where comprehensive health roles are enacted in the context of family and environmental circumstances.

Community Practice Settings

  • Includes outreach services in clinics, schools, occupational health environments, and various community-based institutions.

Schools

  • Major settings where public health nurses facilitate health education and services in collaboration with educational institutions.

Occupational Health

  • Ensures employee health and wellness within workplace settings, contributing to overall public health goals.