Identify your county public health department in the community in which you reside or nearby.? (I live in Scott County MN, zip code is 55378 – for the online research, or you can let m

PART I Foundational Concepts

for Public Health Nursing Practice

1 Introduction to Public Health Nursing Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2 Evidence-Based Public Health Nursing Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

C o p y r i g h t 2 0 1 8 . S i g m a .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 1/15/2023 5:35 AM via MINNESOTA STATE UNIVERSITY – MANKATO AN: 1917387 ; Patricia M. Schoon, Carolyn M. Porta, Marjorie A. Schaffer.; Population-Based Public Health Clinical Manual, Third Edition: The Henry Street Model for Nurses Account: s4200124.main.ehost

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3

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CHAPTER

1Introduction to Public Health Nursing Practice

n Patricia M. Schoon with Marjorie A. Schaffer and Jill Timm

Abby will soon be starting her public health nursing clinical and is struggling with the idea of practicing nursing outside the hospital. She is talking about public health clinicals with Alberto and Sia at lunch. “I can’t imagine myself out in someone’s home, or in a school, or in a community center or public health agency. I’m not sure I know what I’m supposed to do. I also wonder how I will be respected without scrubs or my uniform. Is it really true that one of the most important skills in public health is listening and that sometimes that is all that you do? I feel like I should be doing something more.”

Alberto responds, “My friend, Zack, had public health last semester. He said that it was interesting to consider listening as its own intervention. It was hard to not jump in and ‘teach’ immediately. He often wanted to do more. After a while, he started to get comfortable and also started to understand the benefits of really trying to understand the perspectives of clients in the community.”

Sia comments, “I worry about all of this too. I was talking with Jen, a friend of mine who took public health last year. She said that on her first home visit, she went with her public health nursing preceptor. This gave her a chance to get a sense for the family’s needs and possible interventions.”

Abby says, “I am really worried about being out alone. I wonder what the neighborhood where my family lives will be like and whether I will be safe.”

Sia states, “I’m also curious about the various public health nursing roles that we may be able to observe or do. It seems like the field is so broad and there are so many things to consider.”

ABBY’S NOTEBOOK

USEFUL DEFINITIONS

Client: A client (syn. patient) is the individual/family, community, population or subpopulation, or system that is the public health nurse’s focus of care.

Community: A community can refer to (a) a group of people or a population group, (b) a physical place and time in which the population lives and works, or (c) a cultural group that has shared beliefs, values, institutions, and social systems (Dreher, Shapiro, & Asselin, 2006, p. 23).

Health Determinants: Health determinants are factors that influence the health of individuals, families, and populations. Health determinants can potentially have a positive (protective factors) or negative (risk factors) influence on health.

Health Status: Health status refers to the level of health or illness and is the outcome of the interaction of the multiple health determinants. Health status indicators, also called global measures of population health, include birth, longevity, and death rates (mortality); illness (morbidity) patterns; perception of wellness and life satisfac- tion; level of independence; and functional ability.

(continues)

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4 PART I  n  Foundational Concepts for Public Health Nursing Practice

USEFUL DEFINITIONS (continued)

Holistic Nursing: Holistic nursing is defined as “all nursing practice that has healing the whole person as its goal and honors relation-centered care and the interconnectedness of self, others, nature, and spirituality; focuses on protecting, promoting health and wellness…” (Dossey & Keegan, 2016, p. 3).

Levels of Prevention: The levels of prevention comprise a health-intervention framework applied to the stages of health and disease for individuals and groups (Leavell & Clark, 1958; Stanhope & Lancaster, 2008). The levels of prevention are (a) primary—the prevention of disease and promotion of health; (b) secondary—early diagnosis and treatment; and (c) tertiary— limiting of negative effects of disease and restoring of function.

Population: A population is defined as the “total number of people living in a specific geographic area.” A subpopulation (syn. group or aggregate) “consist[s] of people experiencing a specific health condition; engaging in behaviors that have potential to negatively affect health; or sharing a common risk factor or risk exposure, or experiencing an emerging health threat or risk” (American Nurses Association [ANA], 2013, p. 3).

Population-Based Practice: Population-based practice focuses on the population as a whole to determine its priority needs (Minnesota Department of Health [MDH], 2001).

Public Health: Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole (World Health Organization [WHO], n.d.).

Public Health Nursing: Public health nursing is the practice of promoting and protecting the health of popula- tions using knowledge from nursing, social, and public health sciences. Public health nursing is a specialty prac- tice within nursing and public health. It focuses on improving population health by emphasizing prevention and attending to multiple determinants of health. Often used interchangeably with community health nursing, this nursing practice includes advocacy, policy development, and planning, which addresses issues of social justice (American Public Health Association [APHA], Public Health Nursing Section, 2013, p. 1).

Social Determinants of Health: The social determinants of health are the conditions in which people are born, grow, live, work, and age. The distribution of money, power, and resources at the global, national, and local levels shape these circumstances. The social determinants of health are mostly responsible for health inequities— the unfair and avoidable differences in health status seen within and between countries (Modified from WHO, 2013).

System: A system is an institution or organization that exists within one or multiple communities.

ABBY’S NOTEBOOK

Practicing Nursing Where We All Live Public health nursing care is provided to individu- als, families, communities, and populations through a population-based lens that enables nurses to view their cli- ents within the context of the community in which they and their clients live . All aspects of the client’s life are considered as public health nurses (PHNs) carry out the nursing pro- cess . PHNs practice in their communities, where they can make a difference in the lives of their families, the people they serve, and their communities on a daily basis .

As you practice nursing in a variety of clinical settings, you will become aware that the health of people in your families, neighborhoods, and communities affects every- one in the community both socially and economically . As you read this chapter, consider the concepts presented from both your personal and professional perspectives . As nurses, you are all citizens of the world and have civic and

professional responsibilities to promote health and provide for a safe environment .

In the case study at the beginning of the chapter, Abby and her friends are concerned about providing nursing care in the community . It is difficult for nursing students to think about practicing nursing outside the acute and long-term care settings . Many of the skills that nursing stu- dents learn in the acute or long-term care setting (e .g ., IV therapy, medication administration, tube care) are part of the delegated medical functions of nursing practice, which, by necessity, are priorities when caring for acutely ill, frail, and elderly individuals . In the community setting, most of what PHNs do is part of the independent practice of nursing (e .g ., teaching, counseling, coordinating care), as the focus of public health nursing practice is primary prevention . Components of public health nursing can be practiced in any setting, although they are most often practiced in the

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5CHAPTER 1  n  Introduction to Public Health Nursing Practice

whole to determine the community’s priority health needs (Minnesota Department of Health [MDH], Public Health Nursing Section, 2000, 2001; MDH, Center for Public Health Nursing, 2003) . PHNs in a variety of work settings can carry out population-based practice . To be population based, pub- lic health nursing practice should meet five criteria:

1. Focus on entire populations possessing similar health concerns or characteristics

2. Be guided by an assessment of population health status that is determined through a community health assessment process

3. Consider the broad determinants of health 4. Consider all levels of prevention, with a preference

for primary prevention 5. Consider all levels of practice (individual/ family,

community, system) (MDH, 2001, pp . 2–3; MDH, 2003)

PHNs work in homes, clinics, schools, jails, businesses, religious organizations, homeless shelters, camps, hospitals, visiting nurse associations, health departments, and Indian reservations . Public health nursing is defined by its goals, not by its setting . Although public health nursing is con- sidered a specialty area of practice, its standards include expectations for entry-level baccalaureate nursing gradu- ates . Even at the entry level, PHNs are expected to function as change agents and to help shape the healthcare system to meet the public health needs of the 21st century . This leadership expectation for public health nursing practice is implicit in the American Nurses Association’s Public Health Nursing: Scope and Standards of Practice (ANA, 2013) . The American Public Health Association (APHA) definition of public health nursing, “the practice of promoting and pro- tecting the health of populations using knowledge from nursing, social, and public health sciences” (APHA, 2013, p .  2), implies the importance of the scientific knowledge base for PHN practice .

community . Not all nursing practiced in the community can be described as public health nursing . For example, home care and hospice care, both very important areas of nursing, are practiced in the community and exhibit com- ponents of public health nursing but are not traditionally categorized as public health nursing . As you work through this book and engage in nursing activities, think about how you are integrating the components of public health nursing into your nursing practice . Also, think about how you prac- tice nursing where you live and what your civic and pro- fessional responsibilities are to promote the health of your community .

Public Health The practice of public health nursing includes components of public health and is a part of the broader field of public health . It is important to understand the nature and scope of public health practice . Public health practice focuses on protecting and promoting the health of entire populations . This practice includes the prevention of disease and injury and the promotion of the social conditions and lifestyles that maintain health and prolong life .

Public health professionals monitor and diagnose the health concerns of entire communities and promote healthy practices and behaviors to ensure that populations stay healthy . The World Health Organization uses the term “global public health” to recognize that, as a result of glo- balization, forces that affect public health can and do come from outside state boundaries . Responding to public health issues now requires paying attention to cross-border health risks, including access to dangerous products and environ- mental change (WHO, n .d .) . PHNs need to take a global perspective about the nature of population health threats and issues when practicing in the community .

Public Health Nursing Public health nursing combines the theory and practice of nursing and public health . Public health nursing, like nursing practice everywhere, involves the interaction of the nurse and client; the health of the client; the influence of the home, healthcare, and community environment; and the nursing care provided . One of the unique features of pub- lic health nursing is that the client can be an individual or family, a group of people, or a whole community . The client could also be a system within the community (e .g ., a school, church, or community health or social service agency) . PHNs work to improve population health at the local, state, national, and international levels (ANA, 2013; APHA, 2013) . Public health nursing goals are to promote and preserve the health of populations and the public, prevent disease and disability, and protect the health of the community as a whole .

Public health nursing practice is considered population- based because it starts by focusing on the population as a

Definition of Public Health Nursing Practice

Up to this point in your nursing education, you have focused on nursing care of individuals and families. Public health nursing is population based and focuses on population health. “Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. Public health nursing is a specialty practice within nursing and public health. It focuses on improving population health by emphasizing prevention, and attending to multiple deter- minants of health” (APHA, 2013, p. 1). While public health nursing practices include primary, secondary, and tertiary prevention, the focus is on primary prevention.

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6 PART I  n  Foundational Concepts for Public Health Nursing Practice

in 1881 (Kulbok, Thatcher, Park, & Meszaros, 2012; Kub, Kulbok, & Glick, 2015; see Figure 1 .1) . PHNs saw themselves not only as caregivers but also as advocates for those living in unhealthy conditions and experiencing unmet health- care needs . Care of the ill soon expanded to care of those at risk for poor health and to populations and entire com- munities . Disease prevention and health promotion for vul- nerable or at-risk populations in diverse settings became a second focus .

Until the late 1960s, PHNs working for governmental public health agencies generally provided services to two at-risk populations: mothers and children, and adults living at home with chronic diseases and disabilities . When Medi- care legislation was enacted in 1966, home care became a covered service, and private agencies began to offer home care services (see Chapter 7) . Many public health agencies renewed their commitment to the goals of health promotion, disease prevention, and protection and risk reduction, and they stopped providing home care to adults with chronic diseases and disabilities . PHNs increased their efforts to address the social determinants of health, which are dis- cussed later in this chapter . Today, public health nurses often work with community groups as well as individuals and families . Community engagement, population-based advocacy, collaboration with other community agencies and groups, and community organizing are all part of the scope of practice of public health nurses (see Chapters 2, 5, and 10) . At the same time, nurses practicing in a variety of non-traditional public health settings (e .g ., home care, hos- pice, faith-based nursing, institutional and insurance care coordination and care management, etc .) use public health nursing principles and public health interventions in their practice .

Emerging threats to public health require a dramatic shift in the focus of healthcare, public health, and public health nursing . ANA (2013, p . 2) has identified six 21st- century threats that form a context for the current and future direc- tions of public health nursing practice:

1. Reemergence of communicable disease and increas- ing incidence of drug-resistant organisms

2. Environmental hazards 3. Physical or civic barriers to healthy lifestyles (e .g .,

food “deserts”) 4. Overall concern about the structure and function of

the healthcare system 5. Challenges imposed by the presence of modern

public health epidemics, such as pandemic influenza, obesity, and tobacco-related diseases and deaths

6. Global and emerging crises with increased opportu- nities for exposure to multiple health threats

Nursing continues to expand its leadership role in healthcare in all settings, but in public health nursing, that leadership role often takes place in the community, includ- ing in the public policy–making arena (ANA, 2003, 2013) .

As students, you have already learned about nursing core concepts that also shape public health nursing, which include (Keller, Strohschein, & Schaffer, 2011): n Care and compassion n Holistic and relationship-centered practice n Sensitivity to vulnerable populations n Independent nursing practice

This book also introduces you to additional public health core concepts that shape public health nursing, which include (Keller et al ., 2011): n Social justice n Population focus n Reliance on epidemiology n Health promotion and prevention n The greater good n Long-term commitment to community

Evolution of Public Health Nursing In this chapter, you will read about how nurses practice pub- lic health nursing in the community, and you will consider how important nurses are to the health of communities at the local, national, and international levels . It is important to mention two key founders of public health nursing . Since the time of Florence Nightingale, the first public health nurse, nurses have always been essential participants in improving and maintaining the health of individuals, fami- lies, and communities . Nightingale, who started her nursing career in 1850, provided leadership for the health of vulner- able populations by advocating for changes in the organiza- tions and communities that were responsible for providing healthcare (Selanders & Crane, 2012) . Nightingale focused on managing the environment of those who needed care, whether it was on the Crimean War battlefields or work- ing with the London poor . Her concerns about the impact environmental conditions had on health and her work to advocate for healthful environments is as relevant today as it was in the 1800s (Davies, 2012) . Lillian Wald, the founder of modern-day public health nursing, founded the Henry Street Settlement in 1893 to provide nursing services to the indigent citizens of New York . In 1903, Wald, in collabo- ration with Metropolitan Life, started the first insurance reimbursement for nurse home visiting and demonstrated its effectiveness (Abrams, 2008; Buhler-Wilkerson, 1993) . The Henry Street Settlement House continues to provide health and social services today .

Public health nursing in the United States developed out of a need to provide nursing services to individuals and families who had unmet health needs, and started with Clara Barton, who founded the American Red Cross as a response to the needs of injured and ill Civil War soldiers

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7CHAPTER 1  n  Introduction to Public Health Nursing Practice

‘‘

’’

Cornerstones of Public Health Nursing The Cornerstones of Public Health Nursing (Minnesota Department of Health [MDH], Center for Public Health Nursing, 2007) provide the foundation for population-based nursing practice (Keller et al ., 2011) . The Cornerstones reflect the values and beliefs that guide public health nursing prac- tice, and they are also closely related to the ANA Principles of Public Health Nursing Practice (ANA, 2013), as repre- sented in Table 1 .1 .

These Cornerstones are reflected in PHNs’ daily practice when they: n Organize their workload and schedule based on priority

health needs of clients and community n Take time to establish trust when visiting families in

their homes n Carry out holistic assessments of individuals and

families within the context of culture, ethnicity, and communities

n Use evidence-based practice from nursing and pub- lic health sciences to select appropriate and effective interventions

n Collaborate with other members of the healthcare team n Make critical decisions about the needs of their clients

and the selection, implementation, and evaluation of interventions based on their professional knowledge and professional licensure

A key principle to keep in mind is that PHNs must place more importance on goals related to the public good than goals for the benefit of individuals in the social and eco- nomic systems (see Chapter 13 for a discussion of social jus- tice and Chapter 14 for a discussion of public health nursing leadership) .

“I still don’t really understand how we are going to factor in community or environmental needs when we are working with individuals.” Albert sighs.

Sia responds, “What I remember from our public health theory class this morning is that even though we are meet- ing people in their homes, we have to take into account the home environment and the community. Our instructor also talked about public health nurses having a responsibil- ity to improve the health of the public at the local, national, and international levels. She mentioned that this idea can be overwhelming for nursing students and suggested that we focus on what we could do to improve the health of indi- viduals and families as a way to help improve the health of our community. She used the term ‘glocal,’ which means to think global, but act local.”

Abby adds, “Maybe we should read more about this in our textbook and look at some of the websites suggested.”

“Good idea,” says Sia.

FIGURE 1.1 Public Health Nursing in the United States Sources: Abrams, 2008; Buhler-Wilkerson, 1993; Kub, Kulbok, & Glick, 2015;

Visiting Nurses Association of Western New York, n.d.

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