Population vs Community
Population focused nursing ( where an entire population is the focus or client)
Community based nursing practice where the individual/ family in a community is the patient.
*in public health nursing the community is the patient!
Public Health Nursing (PHN)
Scope and Standards of Public Health Nursing Practice (Quad Council, 1999)
Public Health Nursing is The practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences
trends affecting the PHN/CHN
Need to cover more of population at lower cost.
Americans are living longer ~ 80 yr on average
Care has been shifting from the hospital to the community - increasing # patients in community
Affordable Care Act- increased # American's with health insurance
policies effecting public health
Healthy People 2020 provided goals for all people to live long, healthy lives.
Overall Goal to protect and improve the Physical and Mental health of all Americans.
Patient Protection and Affordable Care Act
Promotes Health Prevention and Promotion,. Creat
benefits of public health practice
-Dramatic increase in life expectancy since 1900s_Mostly through Improved sanitation and control of infectious diseases
-Population-based prevention programs eg anti-smoking programs, have decreased CV death and disability
-Potential to prevent 70% of ear
levels of prevention**
1. primary prevention
implement a community-level program such as walking for exercise to assist citizens in improving health behaviors related to lifestyle
ex)The public health nurse develops a health education program for a population of school-age children that teaches them
1. primary prevention from ppt
using general and specific measures in a population to promote health and prevent the development of disease(incidence) and using specific measures to prevent diseases in those who are predisposed to developing a particular condition.
ex) the public healt
2. secondary prevention
implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center
ex)The public health nurse provides an influenza vaccination program in a community retirement village.
2. secondary prevention from ppt
stopping the progress of disease by early detection and treatment, thus reducing prevalence and chronicity.
ex) the public health nurse develops a program of toxin screenings for migrant workers who may be exposed to pesticides and refers for treatment th
3. tertiary prevention
provide a self-management asthma program for children with chronic asthma to reduce their need for hospitalization
ex)The public health nurse provides a diabetes clinic for a defined adult population in a low-income housing unit of the community.
3. tertiary prevention from ppt
stopping deterioration in a patient, a relapse, or disability and dependency by anticipatory nursing and medical care.
ex) the public health nurse develops a diabetes clinic in which nursing care including educational programs for nutrition and self-care
public health
Public Health is what we as a society do collectively to assure the conditions in which people can be healthy.
Institute of Medicine report 1988
National Public Health Performance Standard Program
-Developed around the 10 essential public health services
-Focus on the overall public health system rather than on single organizations
-Describe an optimal level of performance
-Support a process of quality improvement
-From Core Functions Project, US P
public health core functions
All levels of services shown in the pyramid are important to the health of the population and thus must be part of a health care system with health as a goal.
It has been said that "the greater the effectiveness of services in the lower tiers, the greater
Core Performance Competencies of ALL Public Health Professionals
-Analytic/assessment abilities
-Policy development/program planning
-Communication
-Cultural competency
-Community dimensions of practice
-Basic public health sciences
-Financial planning and management
-Leadership and systems thinking
different stages of a career
- Tier 1 applies to entry level public health professionals without management responsibilities.
-Tier 2 competencies are expected in those with management and/or supervisory responsibilities.
-Tier 3 is expected of senior managers and/or leaders in publi
core competency expected of each tiers
-Tier 1 competencies are expected of Entry level personnel. Non-management
-Tier 2 Management in a CHN or PHN org Supervisory Responsibilities
-Tier 3 competencies are expected of Senior managers /senior leaders
Leaders in Public Health organizations
PHN Specialists and Core Public Health Functions: Assessment
Participate in and provide leadership for:
-Assessing community needs, health status of populations within the community, and environmental and behavioral risks
-Look at trends in the health determinants
-Identify priority health needs
-Determine/assess t
PHN Specialists and Core PH Function: Policy Development
-Core function AND core intervention strategy
-Seeks to build constituencies that can help bring about change in public policy
-Examples:
_Development of Healthy People 2020 state objectives
_National effort to control acquired immunodeficiency syndrome (
PHN Specialists and Core PH Functions: Assurance
Ensure that PHN policies and activities meet public health goals and plans
Includes the development of partnerships between public and private agencies
Promote knowledge and behaviors that support and meet public health.
Curriculum Content Areas for Public Health Accreditation
-Informatics
-Genomics
-Cultural competence
-Community-based participatory research
-Policy
-Law
-Global health
-Ethics
*The Institute of Medicine released a report, "Who Will Keep the Public Healthy?" (2003b), which identified eight content areas in whic
public health nurse
Received: Specific education, preparation and supervised clinical practice in PNHing beginning at BSN level.
**COMMUNITY-ORIENTED NURSING PRACTICE
a philosophy of nursing service delivery that involves the generalist or specialist public health and community health nurse. The nurse provides health care through community diagnosis and investigation of major health and environmental problems, health s
**COMMUNITY-BASED NURSING PRACTICE
a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. the emphasis of community-based nursing practice is acute and chronic care and the provision of comprehensive, coordinated, and continu
public health nursing specialty
Characteristics:
-Population-focused-emphasis on populations
-Community-oriented-connect pop health status w/environment where the pop lives
-Health and preventation focus-health promotion
-Interventions are made at the community or population level
-*The
public health nursing
is a specialty because it has a distinct focus and scope of practice, and it requires a special knowledge base.
It is population-focused. Primary emphasis is on populations whose members are free-living in the community as opposed to those who are institu
Essential Areas for the Preparation of PHN Specialist (Box 1-4)
Epidemiology
Biostatistics
Nursing theory
Management theory
Change theory
Economics
Politics
History of public health
Issues in public health
Public health administration
Community assessment
Program planning and evaluation
Interventions at the aggregate
Education for PHN
1. current: BSN graduate has basic preparation to function as a staff PHN
+ Master's degree required for specialization in PHN_ then eligible to sit for certification exam
2. Future: Doctor of Nursing practice will likely be required for specialization in
8 principles of public health nursing
1. the client or 'unit of care' is the population
2. the primary obligation is to achieve the greatest good for the greatest number of people or the population as a whole
3. the processes used by public health nurses include working with the clients as an
Definitions of Population-Focused Practice
1.Population or Aggregate
-A collection of individuals who have one or more personal or environmental characteristics in common
-Members can be defined in terms of: a_Geography (e.g, persons in a county, a group of counties, or a state)
b_Special interest
Population-Focused Practice Versus Individual-Focused Practice
Population-Focused Practice:
Diagnoses, interventions, and treatments are carried out for population or subpopulation
Levels of prevention (primary, secondary, tertiary)
Population-level decision making is different
Concerned with more than one subpopulat
Population-level decision making is different from decision making in clinical care.
For example, in a clinical, direct care situation, the nurse may determine that a client is hypertensive and then explore options for intervening. However, at the population level, the public health nursing specialist might explore the answers to the foll
level of health care practice
1. community level:denote the entire community. Public health nursing specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community.
2. population level (aggregate): denote the subpopulations. Th
PHN and Community Health Nursing Versus Community-Based Nursing
PHN:
1.
Community-oriented, population-focused strategies
2. Community-based combination of population-focused, community-oriented strategies and direct-care clinical strategies
3. Emphasis on free-living populations where prevention has the greatest impa
4 key areas community nursing
1. community oriented
2. public health
3. community health
4. community based
roles in PHN
1. public health nursing administrators
2. PHN staff nurses
3. PHN educators plan curriculum to prepare staff nurse or generalist
4. identification of skills and necessary knowledge
Challenges for the future
Barriers to specializing in PHN:
1. Changing mindset that nursing is only at bedside
2. Work structure and role socialization
3. Few nurses receive graduate-level preparation in PHN concepts and strategies
Developing population-focused nurse leaders
Shift
definition: heatlh
a state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity
health promotion_def
activities that have as their goal the development of human attitudes and behaviors that maintain or enhance well-being.
institute of medicine _ def
a part of the national academy of sciences, and an organization whose purpose is to provide national advice on issues relating to biomedical science, medicine, and health.
primary care_ def
the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with clients, and practicing in the context of family and comm
primary health care_ def
a combination of primary care and public health care made universally accessible to individuals and families in a community, with their full participation, and provided at a cost that the community and country can afford.
public health_ def
organized community and multidisciplinary efforts, based on epidemiology, aimed at preventing disease and promoting health
globalization_ def
a trend toward an increased flow of goods, services, money, and disease across national borders.
disparities_def
racial or ethnic differences int eh quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention
changes
1.Affordable Care Act of 2010: mandated health insurance for all. Provides subsidies for poor or middle class to obtain it.
2.Aging Baby Boomer population_Will increase Medicare expenditures
3. Medicaid expanded under ACA in some states. Not in others. Un
where the health care billions went in 2008
The largest share of health care expenditures goes to pay for hospital care, with physician services the next largest item.
It is obvious when looking at this chart that the amount of money that has gone to pay for public health services is much lower tha
Access_ who gets care
Strong relationship between health insurance coverage and access to health care services=>better health status. Uninsured less preventative care.
Groups who face greatest barriers to access:
a.Poor- even with Medicaid access is difficult
b.Minority group
The community health center is the backbone of the safety net system. These centers are public, nonprofit, and receive funding from the federal government. Characteristics of these centers include the following:
They must be located in or serve a high-need or medically underserved community, which can be rural or urban.
They must provide comprehensive primary care services and supportive services, such as translation and transportation services.
Their services mu
American Recovery and Reinvestment Act of 2009 (ARRA)
an economic stimulus package designed to offset some of the losses related to the recession, provided two billion dollars in additional funding for the nation's community health centers, including a substantial amount of money to cover the increased deman
Quality
To Err is Human: Building a Safer Health System (IOM,2000, 2016)
-225,000 deaths due to medical error 2016
Desire for Cultivation of a culture of safety:
a. Sentinel events (death, injury, adverse outcomes) required to be reported
b.Accreditation- JACHO a
workforce issues
-periodic shortages in primary care providers
- growing number NPs- many of whom practice primary care
(diversity in health care workforce; Pew Commission- fewer than expected % in minority MD's and RN's; more aides, and home care attendants minorities)
Changing Technology
Examples:
-Telehealth- video long distance care, good for underserved rural areas
-Electronic medical records- computerized records are becoming universal
Benefits:
-Cost-effective
-24 hr availablity
-Improved coordination ,quality of care, and quality mo
electronic medical records
EHR has been called the most important innovation for patient safety, and was endorsed by Health and Human Services (HHS) Secretary Leavitt (under President Bush) as the means to create a system in which information is digital, privacy-protected, and inte
Global influences
Globalization-faster movement of people, viruses, cultures across borders. PHN many have patients from many different cultures
Infectious disease outbreaks- Ebola, Sars
, H1N1, Zika viruses- all recent global/regional
events. Will be in the community.
PHN
organization of the health care system
Primary Health Care System
Primary Care
Public Health System
The Federal System
The State System
The Local System
Key points
1. health care in the united states is made up of a personal care system and a public health system, with overlap between the two systems
2. primary care is a personal health care system that provides for first contact and continuous, comprehensive, and c
Primary Care
as defined here, is a component of the private health care system. The care that is provided by a health care professional (either a physician, physician assistant, or nurse practitioner) trained in family practice, pediatrics, or internal medicine. Also
Primary health care (PHC)
the focus of the public health system in the United States, is defined as a broad range of services, including but not limited to basic health services, family planning, clean water supply, sanitation, immunization, and nutrition education; it consists of
Primary care-personal health care system
Care provided by health care professional
Care provided at the individual level
Via private or public insurance
Office or clinic based
PHC essential care made universally acessible
-integration of public and primary care
Broad range of services
Emphasis is on prevention
Care provided at the community level
Global distribution via UN goals
Alama-Alta Health for all
PHC
promotes the integration of all health care systems w/in the community to come together . Health promotion, disease prevention and curative care.
Declaration of Alma Ata (1978)
Goal of attaining a level of health that permits all citizens of the world to live socially and economically productive lives
- Healthy people 2020 broad goals for healthy citizens in US
Integration of Public Health and Primary Care (PHC)
Historically separate systems in US
IOM in US formed committee to examine integration of systems.
Purpose integration per WHO-primary health care
Barriers: Different functions, foci and funding.
PC :person focused, ct or insurance pays
PH: community focus
primary care and primary health care may sound similar, but the services provided are different. primary care, as defined here, is a component of the private health care system. It is the care provided by a physician, physician assistant, or nurse practit
Primary care: basic care; first contact with a health provider and health system; includes preventive, curative, and rehabilitative care
secondary care: provided by a specialist health care provider usually after referral from a primary care provider
tert
**Public health system
Mandated through laws that are developed at the national, state, or local level
Organized into many levels in the federal, state, and local systems
At the local level, health departments provide care that is mandated by state and federal regulations.
(Exa
Managed care in Primary care
defined as a system in which care is delivered by a specified network of providers who agree to comply with the care approaches established through a case management process, was a strategy chosen by the federal government as a means to control the rising
HMOs - health maintenance organization from managed care
a form of health care in which an insurer collected premiums and paid a negotiated fee to a group of doctors to provide care, or as in the staff model, the HMO employed the doctors directly. Kaiser Permanente is an example of such an HMO.
Preferred provider organizations (PPOs)
groups of health care providers agree to provide services at discounted rates to an enrolled population
Point of service (POS)
model in which an insurer allows enrollees to use providers outside of a specified network for an additional fee
Medicare advantage program
introduced the managed care model into medicare and medicaid
*medicare: >65 and disabled
*medicaid- poor
medicaid
1.federal and state share expenses
2. 43.5 million enrollees in 2008
3. state administered; state programs vary
4. lo-income families with children who meet eligibility requirements
5. disabled who meet eligibility requirements
6. poor elderly "dual eligi
State health department
Disaster prevention, emergency response
and readiness, disease outbreak care
Health care financing and administration
Oversight of Professional education . Board of examiners-nurses, PT, OT etc
Direct assistance to local health departments_Ongoing assessm
local health department
1. direct responsibility to the citizens on its community or jurisdictions
2. variety of services and programs offered-eg immunization and TB clinics
3. health code development and enforcement
4. community needs
5. funding and resources.