Public Health Nursing
is a specialty because it has a distinct focus and scope of practice, and it requires a special knowledge base.
The following characterizations distinguish public health nursing as a specialty:
There is a health and preventive focus The
Interventions are made at the community or population level.
Political processes are used as a major intervention strategy to affect public policy and achieve goals.
•here is concern for the health of all members of the population/community, particularly vulnerable subpopulations.
Population or aggregate
is a collection of individuals who have one or more personal or environmental characteristics in common.
Public Health Core Functions
assessment, policy development, and assurance.
Public Health Essential Services
1.Monitor health status to identify community health problems.
2.Diagnose and investigate health problems and hazards in the community.
3.Inform, educate, and empower people about health issues.
American Nurses Association
American Public Health Association
"The Definition and Role of Public Health Nursing in the Delivery of Health Care" to describe the field of specialization
In Public Health Nursing: scope and standards of practice.
Visiting Nurses Association
"The Visiting Nurse Quarterly" initiated a professional communication medium for clinical and organizational concerns.
Institute of Medicine IOM defined public health as:
What society does collectively to ensure the conditions in which people can be healthy.
Topic of Interest for Public Health Nurse:
Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders
A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to:
Opinions that nursing should focus on the provision of direct client care and services. (pg) 18
The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is:
Assurance Pg 14
The role and goals of the community health nursing practice can best be described as:
Population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. Pgs 15-17
A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of:
Assessment. Pgs 7, 14
A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of:
Clinical community health practice
A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing:
Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is:
Director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system (pg 18-19)
Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with:
more than one subpopulation and frequently with the health of the entire community (pg 12)
Public health nursing specialists are interested in which of the following topic(s)?
Evaluation of an outreach program for at-risk pregnant teenagers
Community subpopulations with high rates of type 2 diabetes
Prevalence of hypertension among various age, race, and gender groups
Community-Based Nursing Responsibilities
Managing acute or chronic conditions among individual clients and families.
Care is family-centered
Setting is community based
emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings.
Clinical community health practice
Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.
Racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention.
LEVELS OF PREVENTION
Measures that actively promote health, prevent illness, and provide protection.
Example: Health Promotion and Education; Targets essentially well populations
Early diagnosis and prompt interventions to limit disabilities
Pap smear, mammogram, physical;Screening, Testing
Reduce impairments and disabilities, minimize suffering, promote adjustment to immediate condition ,and rehab
In 1860, Nightingale established the first nursing program in London. It was hospital based, but the curriculum contained not only care of the sick, but also public health concepts with their inherent ethical tenets. Many of these programs were associated with religious institutions. Students, therefore, often received ethics courses with a slant toward a particular religion's values.
founded the Henry Street Settlement and Visiting Nurse Service which provided nursing and social services and organized educational and cultural activities. She is considered the founder of public health nursing
Henry Street Settlement
1st public health nursing practice staffed by both nurses and social workers. (Due to Lillian Wald)
American Red Cross
A disaster relief organization founded in Washington, D.C. on May 21, 1881 by Clara Barton to aid US military and conduct peace time relief work.
World Health Organization
An international agency that is sponsored by the United Nations. It is the directing and coordinating authority on international health. A primary goal of this organization is to help all the people to attain the highest possible levels of health. The agency compiles international health statistics and info. on disease and publishes health information. It also provides training.
Healthy People 2020
emphasizes the concept of social determinants of health—that is, the notion that health is impacted by many social, economic, and environmental factors that extend far beyond individual biology of disease. This means that improving health requires a broad approach to including the concept of health in all policies and creating environments where the healthy choice is the easy choice.
in contrast, is a set course of action to obtain a desired health outcome for an individual, family, group, community, or society. Policies are made not only by governments, but also by such institutions as a health department or other health care agency, a family, or a professional organization.
Nurse Practice Act
Created by legislation known as a state nurse practice act, the board of nursing is made up of nurses and consumers. The functions of this board are described in the nurse practice act of each state and generally include licensing and examination of RNs and licensed practical nurses; licensing and/or certification of advanced practice nurses; approval of schools of nursing in the state; revocation, suspension, or denying of licenses; and writing of regulations about nursing practice and education.
theory helps one look at national and community issues that affect health care.
Focuses on the Big Picture
theory shows how supply and demand can be used in health care.
Supply and Demand
Efficiency and effectiveness
Gross National Product (GNP)
Total value of goods and services
Gross Domestic Product
Total value of goods and services produced in 1 year
Plus services performed by foreign subjects in the US
Minus services performed in other countries by US citizens
With the beginning of the insurance (or third-party payer) system, health care costs were set by payers, and they determined the type of care or service that would be offered and its price.
A formal regulated program of care delivered by a variety of healthcare professionals in a patients home
Improve quality of life for people who are no longer able to benefit from curative interventions.
nursing are specialized areas of practice designed to "provide evidence-based physical, emotional, psychosocial, and spiritual or existential care to individuals and families experiencing life-limiting, progressive illness"
Faith community nursing, also known as parish nursing, is a concept that began in the late 1960s in the United States when increasing numbers of churches employed registered nurses to provide holistic, preventive health care to congregation members. Faith community nursing is a model of care that uses nurses based within faith communities such as churches and synagogues to provide health services to the members of those communities.
Engage in Community Outreach
Carry out research
is the specialty practice that focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment.
a nursing care pattern; RN's coordinates a person's care from admission through discharge and into the home setting
begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem. This is accomplished by building relationships with the appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome)
Effective disaster plans are designed by those with knowledge of the work processors and materials, the workers and workplace, and the resources of the community.
Host, agent, & environment
Ex: Host-Person; Agent- Mosquito; Environment- swampy environment in tropical region; disease- malaria
Focused on the welfare population;Single parents with dependant children; Aged, blind, and disabled
Enacted in 1965; Provides federal matching funds to states to finance care
Created in 1994; Replaces ___ original Medicaid program
Cover Kids TN
provides free, comprehensive health coverage for qualifying children 18 and younger.
The coverage includes an emphasis on preventive health services and coverage for physician services, hospital visits, vaccinations, well-child visits, healthy babies program, developmental screenings, mental health, vision and dental care.
There are low co-pays for medical services, though well child visits and immunizations are covered at 100 percent.
Medicare Part A
Medicare Part B
Medicare Part C
Medicare Advantage Plans
Example: Plans that supplement A & B
Medicare Part D
Prescription drug reimbursement plans offered to Medicare beneficiaries
Primary Health Care
it is general in scope, accessible, integrated (including health promotion, disease prevention, cure and care, rehabilitation and palliation), continuous, dependent on teamwork, holistic, personal (focusing on the person rather than the disease), family and community oriented, coordinated, confidential (respecting the client's privacy), and playing an advocacy role.
Primary Health Care Provider
A physician who usually is the first physician to examine a patient and who recommends secondary care physicians with expertise in the patient's specific health problem, if further treatment is needed
Government Health Care Functions
Federal, state, and local governments carry out five health care functions, which fall into the general categories of direct services, financing, information, policy setting, and public protection.
HEALTHY PEOPLE 2020
Provides science based, 10 year national objectives for improving the health of all Americans