Week 2: Omaha System Case Study & Home Visiting Go to Omaha System Case Studies: https://www.omahasystem.org/casestudies The case studies are listed at the bottom of the page (Emma, Janice,

Public/Community Health and Nursing Practice

CARING FOR POPULATIONS

SECOND EDITION

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Public/Community Health and Nursing Practice

CARING FOR POPULATIONS

SECOND EDITION

Christine L. Savage, PhD, RN, FAAN Professor Emerita

Johns Hopkins University School of Nursing Baltimore, Maryland

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F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com

Copyright © 2020 by F. A. Davis Company

Copyright © 2020, 2016 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.

Printed in the United States of America

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As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is ad- vised always to check product information (package inserts) for changes and new information regarding dose and contraindi- cations before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.

Library of Congress Cataloging-in-Publication Data

Names: Savage, Christine L., author. Title: Public/community health and nursing practice : caring for populations

/ Christine L. Savage. Other titles: Public health science and nursing practice Description: 2nd edition. | Philadelphia : F.A. Davis Company, [2020] |

Preceded by: Public health science and nursing practice / Christine L. Savage, Joan E. Kub, Sara L. Groves, 2016. | Includes bibliographical references and index.

Identifiers: LCCN 2019007149 (print) | LCCN 2019008721 (ebook) | ISBN 9780803699878 (ebook) | ISBN 9780803677111 (pbk.)

Subjects: | MESH: Public Health Nursing | Community Health Nursing | Health Planning | Population Characteristics

Classification: LCC RT97 (ebook) | LCC RT97 (print) | NLM WY 108 | DDC 610.73/4—dc23

LC record available at https://lccn.loc.gov/2019007149

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To my husband, Joe, for all his love and support.

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Preface

The World Health Organization (WHO) partnered with the International Council of Nursing and began the Nursing Now campaign that “… aims to improve health by raising the profile and status of nursing worldwide” (WHO, 2018). They recognized that nurses provide care essential to the optimizing of health for individuals, fam- ilies and communities. Health occurs from the cellular to the global level; thus nurses must have knowledge re- lated to health across this continuum. Nursing education often begins with understanding health at the cellular level through courses related to pathophysiology and physical assessment. Building on this knowledge, this text covers health, disease, and injury within the context of the world we live in. No matter what settings nurses work in, they apply public health science on a daily basis to prevent disease, reduce mortality and morbidity in those who are ill, and contribute to the health of the com- munities we serve. Our goal with this book is to lead you on the journey of discovering how the public health sci- ences are an integral part of nursing practice and how nurses implement effective public health interventions.

About This Book This book presents public health in a way that captures the adventure of tackling health from a community- and population-based perspective. Public health helps us to answer the question, “Why is this happening?” and to im- plement interventions that improve the health of popu- lations. Public health issues are usually messy real-world problems that do not always have obvious solutions. You will learn through the examples provided how to gather the needed information to understand important health issues, especially those included in Healthy People. You will have an opportunity to explore population-level, evidence-based interventions and learn how to evaluate the effectiveness of those interventions. We aim to pro- vide you with the knowledge to achieve the competencies in public health you increasingly need as a professional nurse across multiple settings. You will be provided with numerous examples of how public health nurses integrate nursing and public health, with a focus on promoting the health of populations.

The application of public health knowledge in the provision of care and the prevention of disease is not new to the nursing profession. Florence Nightingale is often viewed as the first nurse epidemiologist because of her work in the Crimean War. She applied public health science to nursing practice in a way that saved lives and improved outcomes, both in the context of war and back in England, with the development of professional nurs- ing in hospital and home settings. As nurses practicing in the 21st century, we follow in her footsteps. Consider nurses working in primary care with mothers and chil- dren or those working in low-income countries facing epidemics of tuberculosis and HIV/AIDS. How does knowledge of public health science enhance our ability to address these complex health issues? Before we can improve health outcomes, we must understand the nat- ural history of disease, the social context in which these health issues arise, and the resources critical to address- ing all of the barriers to care. Knowledge of public health and how it applies to nursing practice has taken on in- creased importance as we move from a fee-for-service model of care to a health-care system that rewards pre- vention of disease.

Nurses must know how to apply the basics of the pub- lic health sciences such as epidemiology, social and be- havioral sciences, and environmental health. They must also meet the Quad Council generalist core competencies such as community assessment, health planning, and health policy. To help you to do that, we have employed a problem-based learning approach to the presentation of the material in this book so that you can apply the principles of public health to real-life nursing settings.

Throughout the book, case studies demonstrate how the application of the public health sciences and public health practice to nursing practice is essential to the pro- motion of health and the prevention of disease. At times, the focus will be on solving health-related mysteries and how that leads to the implementation of interventions to address the health problems at the population level. At other times, the focus will be on the application of the public health sciences to the development and imple- mentation of evidence-based, population-level interven- tions aimed at addressing the health issue.

vii

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Although there have been significant improvements in health during the past 100 years, achieving our stated health goals, whether it be Healthy People goals and objectives or global goals, continues to be a chal- lenge. The ability of each individual, family, and com- munity to lead a healthy and productive life involves an interaction among ourselves, our environment, and the communities in which we live. Understanding the multiple determinants of health, including social determinants that significantly influence health dispar- ities and health inequities, is an essential skill for nurses. The public health sciences help us understand the complexity of the interaction of external and inter- nal forces that shape our health. The premise of this book is that all nurses require adequate knowledge of the public health sciences and how to apply it to nurs- ing practice across all settings and populations. With this knowledge, we can truly contribute to the building of a healthy world.

Organization of the Text The philosophical approach to this text is that all profes- sional nurses incorporate population-level interventions no matter what the setting. We include not only chapters on the traditional public health settings such as the public health department and school health, but also chapters on acute and primary care settings. The book uses a con- structivist learning approach by which the learner con- structs her or his own knowledge. Thus, the content is delivered by applying the information within the context of the real world.

This text uses a problem-based learning approach so that the student can apply the content to nursing prac- tice. It is organized into three units. Unit I, Basis for Public Health Nursing Knowledge and Skills, covers the essential knowledge based in the public health sciences and core public health nursing competencies needed to solve health problems and implement evidenced-based interventions at the population level. This unit provides the basic public health knowledge needed by all gener- alist nurses. The content covered in these chapters is applied across the next two units of the book. Unit II, Community Health Across Populations: Public Health Issues, covers health issues that span populations and settings including communicable and noncommunica- ble disease, health disparity, behavioral health, and global health. Unit III, Public Health Planning, covers the settings in which nurses practice, public health policy, and disaster management.

Understanding health within the context of commu- nity includes understanding the role of culture. To help underscore the importance of culture, it has been inte- grated across each of the chapters rather than have a stand-alone chapter dedicated to culture. In each chapter there is a callout box related to the role of culture specific to the subject of that chapter.

Global health is the other concept now integrated across all of the chapters. In earlier public health textbooks, the term most often used was ‘international health’. As it became clearer that the health of one nation does not occur in a vacuum, but rather contributes to the health of the globe, global health became the accepted term. To truly adhere to the concept that health is global across all set- tings, we have included a cellular to global box in every chapter relevant to the content in that chapter. As nurses dedicated to optimizing health for all, visualizing health within a global context will help us join with the WHO in promoting nursing as a true force in health.

Key Features t CASE STUDIES Throughout the book, the student will find case studies embedded in the chapters that provide essential content within the context of actual nursing practice. This ap- proach begins with the issue and walks the reader through the process of deciding how best to address the problem presented. In some of the cases presented, the object is to solve the mystery (Solving the Mystery), such as the case in Chapter 8 that walks through how to solve the mystery of why people are presenting at the emergency depart- ment with severe gastrointestinal symptoms. Other cases (Applying Public Health Science) describe how nurses apply the public health sciences, such as epidemiology, to help develop and implement evidence-based interven- tions at the population level. There is a standard case study at the end of selected chapters. For instructors, there is online access on the DavisPlus website for the book to a problem-based learning exercise that can be used to fur- ther apply the content presented in the chapter.

n HEALTHY PEOPLE Healthy People is referenced throughout, including Healthy People 2020 and information on Healthy People 2030 available prior to publication. Boxes are included that present the Healthy People 2020 objectives and the midcourse reviews on progress towards meeting those objectives.

viii Preface

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n EVIDENCE-BASED PRACTICE BOXES

Evidence-Based Practice (EBP) boxes illustrate how re- search and its resulting evidence can support and inform public health nursing practice. Cutting-edge EBP is a strong underpinning of the book as a whole.

LEARNING OUTCOMES AND KEY TERMS

Each chapter begins with Learning Outcomes and a list of Key Terms that appear in boldface and color at first mention in a chapter.

Teaching/Learning Package Instructor Resources Instructor Resources on DavisPlus include the following:

• NCLEX-Style Test Bank • PowerPoint Presentations • Instructor’s Guide with PBL exercises

• Problem-Based Learning PowerPoint Presentation • Case Study Instructor's Guides for end-of-chapter

case studies • QSEN Crosswalk • Quad Council Competencies • Simulation Experiences

Student Resources Student Resources on DavisPlus include the following:

• Student Quiz Bank • Student Guide to Problem-Based Learning • List of Web Resources • QSEN Crosswalk • Quad Council Competencies

We hope you will enjoy this book and, most of all, we hope as nurses you will always care for the health of populations no matter the setting, thus increasing the contribution of nursing to the goal of optimal health for all.

Preface ix

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Contributors

Laurie Abbott, PhD, RN, PHNA-BC Assistant Professor

Florida State University College of Nursing Tallahassee, Florida

Chapter 13

Kathleen Ballman, DNP, APRN, ACNP-BC, CEN Associate Professor of Clinical Nursing, Coordinator, Coordinator of Adult-Gerontology Acute Care Programs

University of Cincinnati, College of Nursing Cincinnati, Ohio

Chapter 14

Derryl E. Block, PhD, MPH, MSN, RN Dean, College of Health and Human Sciences

Northern Illinois University DeKalb, Illinois

Chapter 21

Susan Bulecza, DNP, RN, PHCNS-BC State Public Health Nursing Director

Florida Department of Health Tallahassee, Florida

Chapter 13

Deborah Busch, DNP, RN, CPNP-PC, IBCLC Assistant Professor

Johns Hopkins School of Nursing Baltimore, Maryland

Chapter 17

Amanda Choflet, DNP, RN, OCN Director of Nursing, Johns Hopkins Medicine Department of Radiation Oncology & Molecular Radiation Sciences

Baltimore, Maryland Chapter 11

Christine Colella, DNP, APRN-CNP, FAANP Professor, Executive Director of Graduate Programs

University of Cincinnati, College of Nursing Cincinnati, Ohio

Chapter 15

Joanne Flagg, DNP, CRNP, IBCLC, FAAN Assistant Professor, Director MSN Programs

Johns Hopkins School of Nursing Baltimore, Maryland

Chapter 17

Gordon Gillespie, PhD, DNP, RN, PHCNS-BC, CEN, CPEN, FAEN, FAAN Professor, Associate Dean for Research, Deputy Director Occupational Health Nursing Program

University of Cincinnati Cincinnati, Ohio

Chapters 5, 20, & 22

Bryan R. Hansen, PhD, RN, APRN-CNS, ACNS-BC Assistant Professor

Johns Hopkins School of Nursing Baltimore, Maryland

Chapter 10

Barbara B. Little, DNP, MPH, RN, PHNA-BC, CNE Senior Teaching Faculty

Florida State University Tallahassee, Florida

Chapter 13

Minhui Liu, RN, PhD Post-doctoral

Johns Hopkins University School of Nursing Baltimore, Maryland

Chapter 19

Donna Mazyck, MS, RN, NCSN, CAE Executive Director

National Association of School Nurse Silver Spring, Maryland

Chapter 18

Paula V. Nersesian, RN, MPH, PhD Assistant Professor

Johns Hopkins University School of Nursing Baltimore, Maryland

Chapter 16

xi

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Michael Sanchez, DNP, ARNP, NP-C, FNP-BC, AAHIVS Assistant Professor

Johns Hopkins School of Nursing Baltimore, Maryland

Chapters 8 & 11

Phyllis Sharps, RN, PhD, FAAN Professor Associate Dean for Community Programs and Initiatives

Johns Hopkins University School of Nursing Baltimore, Maryland

Chapter 17

Christine Vandenhouten, PhD, RN, APHN-BC Associate Professor (Nursing & MSHWM Programs Chair of Nursing and Health Studies, Director of BSN-LINC

University of Wisconsin, Green Bay Professional Program in Nursing Green Bay, Wisconsin

Chapter 21

Erin Rachel Whitehouse, RN, MPH, PhD Epidemic Intelligence Service Officer at Centers for Disease Control and Prevention

Atlanta, Georgia Chapter 3

Erin M. Wright, DNP, CNM, APHN-BC Assistant Professor

Johns Hopkins School of Nursing Baltimore, Maryland

Chapter 17

Contributors to Previous Edition

Sheila Fitzgerald, PhD

Sara Groves, RN, MPH, MSN, PhD

Joan Kub, PhD, MA, PHCNS-BC, FAAN

William A. Mase, Dr.PH, MPH, MA

Mary R. Nicholson, RN, BSN, MSN CIC

xii Contributors

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Reviewers

Kathleen Keough Adee, MSN, DNP, RN Associate Professor

Salem State University Salem, Massachusetts

Lynn P. Blanchette, RN, PhD, PHNA-BC Associate Dean, Assistant Professor

Rhode Island College School of Nursing Providence, Rhode Island

Dia Campbell-Detrixhe, PhD, RN, FNGNA, CNE, FCN Associate Professor of Nursing

Oklahoma City University Kramer School of Nursing Oklahoma City, Oklahoma

Kathie DeMuth, MSN, RN Assistant Professor

Bellin College Green Bay, Wisconsin

Bonnie Jerome-D’Emilia, RN, MPH, PhD Associate Professor

Rutgers University School of Nursing-Camden Camden, New Jersey

Vicky P. Kent, PhD, RN, CNE Clinical Associate Professor

Towson University Towson, Maryland

Kimberly Lacey, DNSc, RN, MSN, CNE Assistant Professor

Southern Connecticut State University New Haven, Connecticut

Charlene Niemi, PhD, RN, PHN, CNE Assistant Professor

California State University Channel Islands Camarillo, California

Phoebe Ann Pollitt, PhD, RN, MA Associate Professor of Nursing

Appalachian State University Boone, North Carolina

Lisa Quinn, PhD, CRNP, MSN Associate Professor of Nursing

Gannon University Erie, Pennsylvania

Delbert Martin Raymond III, BSN, MS, PhD Professor

Eastern Michigan University Ypsilanti, Michigan

Meredith Scannell, PhD, MSN, MPH, CNM, SANE, CEN Nursing Faculty

Institute of Health Professions Charlestown, Massachusetts

Elizabeth Stallings, RN, BSN, MA, DmH Assistant Professor

Felician University Lodi, New Jersey

xiii

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Acknowledgments

This book exists because of the wonderful students I have had over the years and their dedication to improving the health of individuals, families, and communities. Their thirst for knowledge fed my own. I am grateful to my colleagues who I have had the privilege to work with over my nursing career, with a very special thanks to those who contributed to the writing of this book. I would also like to thank Jeannine Carrado, Elizabeth Hart, and Terri Allen at F. A. Davis for their support and guidance throughout the writing of this book. Improving the health of communities thrives on respectful and thoughtful collaboration between many different people, and so does the writing of a text book.

xv

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Table of Contents

Unit I n Basis for Public Health Nursing Knowledge and Skills 1

Chapter 1 Public Health and Nursing Practice 1 Chapter 2 Optimizing Population Health 23 Chapter 3 Epidemiology and Nursing Practice 55 Chapter 4 Introduction to Community Assessment 77 Chapter 5 Health Program Planning 107 Chapter 6 Environmental Health 128

Unit II n Community Health Across Populations: Public Health Issues 157

Chapter 7 Health Disparities and Vulnerable Populations 157 Chapter 8 Communicable Diseases 191 Chapter 9 Noncommunicable Diseases 218 Chapter 10 Mental Health 239 Chapter 11 Substance Use and the Health of Communities 256 Chapter 12 Injury and Violence 283

Unit III n Public Health Planning 313

Chapter 13 Health Planning for Local Public Health Departments 313 Chapter 14 Health Planning for Acute Care Settings 343 Chapter 15 Health Planning for Primary Care Settings 372 Chapter 16 Health Planning with Rural and Urban Communities 398 Chapter 17 Health Planning for Maternal-Infant and Child Health Settings 420 Chapter 18 Health Planning for School Settings 447 Chapter 19 Health Planning for Older Adults 479 Chapter 20 Health Planning for Occupational and Environmental Health 509 Chapter 21 Health Planning, Public Health Policy, and Finance 537 Chapter 22 Health Planning for Emergency Preparedness and Disaster Management 569

Index 607

xvii

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1

Basis for Public Health Nursing Knowledge and Skills

Chapter 1

Public Health and Nursing Practice Christine Savage, Joan Kub, and Sara Groves

LEARNING OUTCOMES

After reading the chapter, the student will be able to:

KEY TERMS

1. Identify how public health plays a central role in the practice of nursing across settings and specialties.

2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health.

3. Investigate determinants of health within the context of culture.

4. Explore the connection between environment, resource availability, and health.

5. Identify the key roles and responsibilities of public health nurses (PHNs).

6. Identify the formal organization of public health services from a global to local level.

Aggregate Assessment Assurance Community Core functions Cultural competency Cultural humility Cultural lenses Culture

Determinants of health

Diversity Ethnicity Global health Globalization Health High-income countries

(HICs)

Life expectancy Low-income countries

(LICs) Lower middle-income

countries (LMICs) Policy development Population health Population-focused

care

Public health Public health nursing Public health science Race Upper middle-income

countries (UMICs)

n Introduction Every day the media presents us with riveting stories: “The flu season—the worst in a decade,” “Flint’s water supply contaminated with high levels of lead,” “School shooting leaves 17 dead,” “Hurricane Maria leaves 80% of Puerto Rico without power and water,” “Zika virus results in con- genital brain damage,” “The homicide rate in Chicago rises,” “More than 80 dead from the Camp Fire in California.” All of these stories reflect the connections among the health of individuals and families, the communities they live in, the

quality of the public health infrastructure, and population- level events such as disasters (natural and manmade), com- municable diseases (CDs), and violence. As nurses, we provide care directly to individuals and families within the context of the communities we serve. That context encompasses diverse and unifying cultures, demographics, geography, infrastructure, resources, and the vulnerability of certain members of the community. That is why under- standing health from a cellular to global level requires a sound grounding in public health science, a central component of nursing science and practice.

U N I T I

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As nurses, we apply public health science daily. Ob- vious examples include infection control nurses, school nurses, and nurses in the public health department. Nurses working in an acute care setting also apply public health science when using protective equipment and caring for a patient in isolation to prevent transmission of a CD. Public health science applies to every setting where nurses work; understanding public health and the science behind it is a core competency of professional

nursing. It is expected that upon graduation an entry- level nurse will be able to integrate knowledge from pub- lic health into their nursing practice. Nurses must apply the nursing process and incorporate knowledge of the ecological and social determinants of health as they care for individuals and families, and by extension commu- nities and populations. Finally, they are expected to be able to evaluate health within a global context and demonstrate cultural humility in the care of individuals, families, communities, and populations.1 According to the American Nurses Association’s (ANA) Scope and Standards, the importance of public health is clear.2 Other competencies grounded in public health include infection control (Chapter 8), emergency preparedness and disaster management (Chapter 22), environmental health (Chapter 6), and a basic understanding of epi- demiology (Chapter 3).

Public Health Science and Practice What exactly is public health science? Public health sci- ence is the scientific foundation of public health practice and brings together other sciences including environ- mental science, epidemiology, biostatistics, biomedical sciences, and the social and behavioral sciences.3,4

Thus, public health science, as a combination of sev- eral other sciences, allows us to tackle health problems using a wide range of knowledge. We apply the results of public health science to deal with health problems on a regular basis. For example, the evidence that underlies the reliability and validity of screening and diagnostic test results comes from the analysis of population-level data using the science of epidemiology. Public health sci- ence also provides the tools needed to try and solve a problem in the community or in a geographical area.

When confronted with a health problem, health care providers begin with the question “What can we do about it?” This requires an examination of the underlying risks and protective factors related to the health problem, both individual and population based. Based on this type of examination, lead experts in nursing used a population health framework to develop a conceptual model of nurs- ing that reflects the shift from a concentration on indi- vidual health alone to an understanding that health occurs within the context of a population and factors that support or undermine the health of the population as a whole.5 Understanding the factors that contribute to health, both negative and positive, from both a popula- tion and an individual/family perspective allows us to de- velop nursing interventions that incorporate the full continuum of health from individuals to populations,

2 U N I T I n Basis for Public Health Nursing Knowledge and Skills

n CELLULAR TO GLOBAL Health Across the Continuum

The health of individuals occurs across a continuu

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