Public Health Nursing: Present, Past, and Future

Chapter 1: Public Health Nursing: Present, Past, and Future

Chapter Highlights

Healthcare changes in the 21st century

Characteristics of public health nursing

Public health nursing roots

Challenges for practice in the 21st century

Question #1

Is the following statement true or false?

Healthcare disparities are social conditions in which people live and work.

Answer to Question #1

False

Rationale: Social determinants of health are social conditions in which people live and work. Healthcare disparities are gaps in healthcare experienced by one population compared with another.

Major Changes in Healthcare in the 21st Century

Development of patient/client-centered care

Increased use of technology

Increased personal responsibility

Healthcare Changes in the 21st Century #1

Social determinants of health are social conditions in which people live, their income, their social status, their education, their literacy level, their home and work environment, their support networks, their gender, their culture, and the availability of health services

Healthcare Changes in the 21st Century #2

Healthcare disparities—differences in healthcare and health outcomes experienced by one population compared with another

Role of Government in Healthcare

Three core functions are as follows:

Assesses healthcare problems

Intervenes by developing relevant healthcare policy that provides access to services

Ensures that services are delivered and outcomes are achieved

Patient Protection and Affordable Care Act (PPACA)

Provide affordable health insurance coverage to most Americans

Lower costs

Improve access to primary care

Preventive care and prescription benefits

Cover pre-existing conditions

Extend young adults’ coverage

Question #2

What is one of the core functions of the role of government in healthcare?

Provide affordable health insurance coverage

Improve access to primary care

Lower costs

Assess healthcare problems

Answer to Question #2

D. Assess healthcare problems

Rationale: Three core functions are to assess healthcare problems, intervene by developing relevant healthcare policy that provides access to services, and ensure that services are delivered and outcomes are achieved. One of the goals of the Patient Protection and Affordable Care Act (PPACA) is to provide affordable health insurance coverage.

Patient/Client-Centered Care

Cultural traditions

Personal preferences

Values

Families

Lifestyles

Technology

Rapidly advancing forms of technology are dramatically improving lives.

Health Information Technology

Health information technology (HIT)—comprehensive management of health information and its exchange between consumers, providers, government, and insurers in a secure manner

Electronic health records

Telehealth

Use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration

Personal Responsibility for Health

Active participation in one’s own health through education and lifestyle changes

Public Health Nursing

Public health nursing—population-based practice, defined as a synthesis of nursing and public health within the context of preventing disease and disability and promoting and protecting the health of the entire community

Principles of Public Health Nursing #1

Client or unit of care is the population.

Primary obligation is to achieve the greatest good for the greatest number of people or people as a whole.

Public health nurses collaborate with the client as an equal partner.

Principles of Public Health Nursing #2

Primary prevention is the priority in selecting appropriate activities.

Public health nursing focuses on strategies that create healthy environmental, social, and economic conditions in which populations may thrive.

Principles of Public Health Nursing #3

A public health nurse is obligated to actively identify and reach out to all who might benefit from a specific activity or service.

Optimal use of available resources and creation of new evidence-based strategies is necessary to assure the best overall improvement in the health of populations.

Principles of Public Health Nursing #4

Collaboration with other professions, populations, organizations, and stakeholder groups is the most effective way to promote and protect the health of people.

Scope and Standards of Practice

The American Nurses Association sets the scope and standards for all professional nursing practice.

The publication Public Health Nursing: Scope and Standards of Practice establishes the characteristics of competent public health nursing practice and is the legal standard of practice.

Competencies for Public Health Nursing Practice

Three tiers of practice

Competencies associated with that level of practice

Public Health Intervention Wheel

17 interventions

Actions taken on behalf of individuals, families, communities, and systems to protect or improve health status

Public Health Nursing Interventions

Population-based model

Applied to individuals, families, communities, or within systems

Focuses upon prevention

Education for Public Health Nursing Practice

Public health nursing practice

Baccalaureate degree in nursing (BS or BSN)

Generalist master’s degree as clinical nurse leader (CNL)

Public health nursing specialists in population health

MSN

MPH

MSN/MPH

Doctoral degrees: PhD, DNP, DrPH

Roots of Public Health Nursing

Early civilization

Middle Ages

English Poor Law

Variety of reforms in 1800s

Victorian times

District nursing

Public Health Initiatives in Early America

American social values strongly influenced by British traditions

Need for organized public health system

Lemuel Shattuck

Dorothea Dix

Clara Barton

Lillian Wald

Public Health Initiatives in the 20th Century

Mary Breckinridge

Early 20th-century federal healthcare initiatives

Public health in the second half of the century

The First Decade of the 21st Century

Department of Homeland Security: fosters an all-hazards, all-disciplines approach to emergency management

Must be flexible, be politically active, embrace change, and refresh their knowledge of public health issues on a continual basis

Engaging in Evidence-Based Practice

Evidence-based nursing is the integration of the best evidence available with clinical expertise and the values of the client to increase the quality of care.

Evidence-Based Public Health

Public health endeavor with judicious use of evidence derived from a broad variety of science and social science research

Epidemiology

Science of prevention

Knowledge of the natural history of diseases and the identified (risk) factors that increase a person’s susceptibility to illness

Challenges for Public Health Nursing in the 21st Century #1

Engaging in evidence-based practice

Helping eliminate health disparities in underserved populations

Demonstrating cultural competence

Planning for community change

Contributing to a safe and healthy environment

Challenges for Public Health Nursing in the 21st Century #2

Responding to emergencies, disasters, and terrorism

Responding to the global environment

Public Health Nursing: Present, Past, and Future

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