Exam Blueprint

Module 3: Public Health Policy & Program Management

Define the relationship between nursing practice, health policy, and politics.

• Nursing practice influenced by health policy- sets guidelines for care. 

• Health policy shaped by political decisions / advocacy efforts 

  • Health policy: decisions, plans, actions

    • purpose: to achieve specific health care goals within society 

      • Defines a vision: targets and points of reference for short & medium-term goals 

      • Priorities & expected roles 

      • Builds consensus using stakeholders

      • Informs people 

• politics determine the funding, laws, regulations that impact nursing practice 

Understand the role of nurses in developing public health policy. 

• Advocate for health equity, legislation, EBP, research 

Identify primary agencies that affect public nursing practice.

• American Nurses Association 

  • Relevant to nursing practice, health policy, and social concerns impacting the health of pts 

  • If topic is approved by ANA Board of directors, ANA issues panel appointed to research and draft a position → posted for public comment 

  • Statement revised if necessary and then approved again by board 

• American Academy of Nursing

  • Advancing health policy / practice through generation, and dissemination of nursing knowledge 

  • Create and execute knowledge-driving and policy-related initiates to drive reform of America’s health system 

Discuss the steps of community health program planning.

• Program planning process (FCDEI) 

  • Formulating: defining problem 

  • Conceptualizing: ID potential solutions- literature review 

  • Detailing: consideration of potential solutions 

  • Evaluating (the plan): choosing an option from the potential solutions

  • Implementing: putting the chosen solution into place 

Identify the role of the public health nurse in implementing a community health program. 

• Program implementation: 

  • Action steps

    • First steps: 

      • General plan- describe the intervention (program)

      • Whom to approach first 

    • Approach stakeholders

      • Recipients: what level? 

      • Potential supporters

      • Possible opposition 

      • Funding sources 

    • Role of PHN: what will PHN do to make this program work- CH 9 p 208 

  • Assessment → implementation 

    • ID needs and priority populations 

    • State a population dx

    • Review and evaluate EBI 

    • Develop a policy and implement a program 

Analyze the components of program evaluation.

• Evaluating: collecting data

• ID if outcomes are intended or unintended 

• Adjust and make changes accordingly 

• Evaluation aspects:

  • 1. Relevance—Need for the program

  • 2. Adequacy—Program addresses the extent of the need

  • 3. Progress—Tracking of program activities to meet program objectives

  • 4. Efficiency—Relationship between program outcomes and resources spent

  • 5. Effectiveness—Ability to meet program objectives and the results of program efforts

  • 6. Impact—Long-term changes in the client population

  • 7. Sustainability—Enough resources to continue the program

Understand the objectives identified by Healthy People 2030 related to public health nursing. 

• Healthy People 2030 Goals

  • Attain healthy, thriving lives and well-being, free of preventable disease / death

  • Eliminate health dispariites, achieve health equity, and attain health literacy to improve well-being of all 

  • Create environment that promotes attaining full potential for health & 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 well-being 

My Extra Notes: 

• Government Health Care 

  • Functions 

    • Direct services: providing health care to services to certain idvs

      • Ex: military, medicare (60+), veterans, prisoners, low income 

    • Financing: the largest share of healthcare spending is from the federal government 

    • Info: collect, analyze, and disseminate data about health care and health status of idvs 

    • Policy setting: policy decisions are made at all levels of government 

    • Public protection: provides for the protection of the public’s health through the authority of the constitution 

• Program Mgt

  • Policy: guiding principles 

  • Program: translation of policy into action 

• Head Start Program Performance Standards (1975): First performance standards that detail guidelines for serving children 3-5 - can go to pre-school and it’s paid for by government 

• Nursing Advocacy: influencing others (politics) to adopt specific course of action (policy) to solve problem 

  • Building relationships

    • Letter to lawmakers

    • Money

    • Labor, expertise, influence

    • Grassroots network development 

• Program Management 

  • Program: organized approach to meet needs of x, by fixing a health problem

  • Projects: smaller, organized activities with a limited time frame 

  • Strategic planning: matching of client needs w/ specific provider strengths and resources 

  • Community assessment: population focused approach that views the entire community as the client 

    • Primary data: direct contact w/ community

    • Secondary: data that already exists 

  • Population needs assessment: focuses on pop, its needs, and resources avail to address those needs 

Module 4: Forces Affecting Health Care Delivery: Ethics, Culture, SDOH Review 

Describe ethical principles and theories.

• Principlism: is an approach to problem solving in bioethics that uses the principles of respect for autonomy, beneficence, nonmaleficence, and justice as the basis for organization and analysis of ethical issues and dilemmas

  • Respect for autonomy: right to choice and self determination 

  • Non-maleficence: do no harm

  • Beneficence: do good  

  • Distributive Justice: equitable care  

• Ethics: branch of philosophy that includes both a body of knowledge about the moral life and a process of reflection for determining what persons ought to do or be regarding this life

• Moral distress is an uncontrollable state of self in which one is unable to act ethically

• Values are beliefs about the worth or importance of what is right or esteemed

• Ethical dilemma is a puzzling moral problem in which a person, group, or community can envision morally justified reasons for both taking and not taking a certain course of action

  • Choose btw 2+ morally acceptable options 

• Utilitarianism: maximizing of good and minimizing of harm for the greatest number of people

• Deontology: bases moral obligation on duty and claims that actions are obligatory irrespective of the good or harmful consequences that they produce. 

  • Suggests humans should act on what they think is right, despite any consequences 

• Advocacy: the act of pleading for or supporting a course of action on behalf of a person, group, or community.

• Distributive justice: equitable care

  • Egalitarianism: view that everyone is entitled to equal rights and treatment, and it is the role of government to ensure that this happens. supports welfare rights

  • Libertarianism: advocates for social and economic liberty. Although egalitarianism lacks incentives for individuals, libertarianism emphasizes the contribution and merit of individuals. Rights of idv > any collective rights of society 

  • Liberal Democratic Theory: values both liberty and equality 

• Communitarianism: emphasizes importance of community 

  • Virtue ethics: goal is to enable people to flourish as humans, central to professional ethics in PHN 

  • Care ethics: contribute to preservation of humanity, essence of nursing and core value of PHN 

  • Feminist ethics: equitable distribution of power, connections among gender, disadvantage, and health 

Discuss the process of ethical decision-making.

• Ethical decision making: focuses on process of how ethical decisions are made 

• Ethical Decision-Making Framework

  • ID ethical issues and dilemmas 

  • Find meaningful context 

  • Obtain all relevant facts

  • Reformulate if needed

  • Consider appropriate options

  • Decide and take action 

Consider the ethical tenets underlying the core functions in public health nursing.

• 2 ethical tenets of assessment 

  • Beneficence: competency, virtue ethics or moral character 

  • Nonmaleficience: risk-benefit analysis 

• 3 ethical tenets of policy development 

  • Achieve public good: rooted in citizenship 

  • Service to others over self: 

    • Serve rather than steer

    • Serve citizens not customers

    • Value citizenship and public service above entrepreneurship 

• 2 ethical tenets of assurance

  • Bounded in the ethical principle of justice

  • All persons should receive essential personal health services 

  • Providers of public health services are competent and available 

Describe the role of cultural humility in achieving the public health goals of health equity.

• Steps toward cultural safety: cultural awareness → cultural competence → cultural humility 

• Cultural awareness: self-examination and in-depth exploration of one’s own beliefs and values as they influence behavior 

  • Culturally aware nurses 

    • Are conscious of culture as an influencing factor btw themselves and others 

    • Understand bias of their own behavior 

    • Recognize that health is expressed differently 

• Cultural competence: combo of culturally congruent behaviors, practice attitudes, and policies that allow nurses to use interpersonal communication, relationship skills, and behavioral flexibility to work effectively in cross-cultural situations 

  • Nurse provides care considering the person’s idv culture 

• Cultural humility: lifelong process of self-reflection and self-critique where the idv learns about another’s culture, but also starts with an exam of their own beliefs and cultural identities 

  • Is a process-based framework that require life-long self-reflection and open-minded stance towards others 

Describe major facilitators and barriers to providing culturally sensitive health care for diverse populations. 

• 7 steps for culturally sensitive care: awareness, avoid making assumptions, learn about other cultures, build trust, overcome language barriers, ed patients about med practices, active listenting 

• Barriers: stereotyping, prejudice, racism, ethnocentrism, cultural imposition, cultural conflict, culture shock 

Cite culturally sensitive nursing interventions to promote positive health outcomes for diverse individuals, communities, and organizations.

• Cultural preservation: pts of a particular culture retain and preserve traditional values so they can maintain, promote, and restore health 

• Cultural accommodation: pts of a particular culture accept nursing strategies or negotiate with nurses to achieve good health care outcomes 

  • less change: soy sauce → low sodium

• Cultural repatterning: people of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial 

  • Bigger Differences! More dramatic! - Changing taco toppings 

• Cultural brokering: btw the patient’s culture and the biomedical health care culture on behalf of patients 

  • Being an advocate! 

Understand the impact of social determinants of health (SDOH) and access to health care and the community. 

• SDOH: conditions in the environments, affect wide range of outcomes 

  • Economic stability: 1/10 people in US live in poverty 

  • Education access & quality: educated more likely to be healthier and live longer 

  • Healthcare access & quality: help people get timely health care services. 1/10 people in US don’t have health insurance 

  • Neighborhood & Built Environment

  • Social & Community Context 

Evaluate the role of the public health nurse in providing equitable care. 

• Health Equity: achieved when every person has opportunity to attain their full health potential and no one is disadvantaged from achieving this potential bc of social position or other socially determined circumstances 

• Social justice: providing impartiality and objectivity at a systems or governmental level 

• Why it matters

  • Lack of cultural competence: inc gap in disparities 

  • Improves quality of care, lowers cost 

  • Meet Health People objectives 

Extra Notes: 

• Culture: Set of common beliefs, values, and assumptions about life 

• Race: biologic variation within a pop, same race may be of different cultures

• Ethnicity: shared feeling of peoplehood, relates to cultural factors, equally influenced 

• Health Disparities: higher burden or illness, injury, disability, or mortality experienced by one group relative to another 

• Health Inequalities: are reflected in differences in length of life, quality of life, rates of disease, disability, and death, access to tx (more quantitative) 

• INTERPETER: SPOKEN LANGUAGE 

• TRANSLATOR: TEXT