Chapter 1 Community- and PreventionOriented Practice to Improve Population Health Objectives 1. 2. 3. 4. 5. 6. State the mission and core functions of public health, the essential public health services, and the quality performance standards program in public health. Describe specialization in public health nursing and other nurse roles in the community and the practice goals of each. Describe what is meant by population health. Identify barriers to the practice of community and prevention–oriented, population-focused practice. Describe the importance of the social determinants of health to the health of a population. State key opportunities for nurses in public health practice. 2 Introduction Recently increased attention to public health COVID-19 Pandemic Concern with cost of medical care & the Affordable Care Act (ACA) of 2010 US health & life expectancy worse than other highincome countries Focus of this chapter: Public health as a broad field of practice Population health Public health nursing 3 Public Health Practice (1 of 2) Definition: “what we, as a society, do collectively to assure the conditions in which people can be healthy” (IOM. 1988, p. 1). Mission: “to generate organized community efforts to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health” (IOM, 1988 p. 1; Williams, 1995). Accomplished by many groups (public & private) & individuals, with special function of the government 4 Public Health Practice (2 of 2) Benefits Safer and cleaner environments and food/water Dramatic increase in life expectancy Decreased number of deaths from heart disease and stroke Declines in death rates of adults and children CDC’s (1999) Ten Great Public Health Achievements in the 20th Century Gains made due to public health programs, such as: Safety and adequacy of food supplies Provision of safe water Sewage disposal Public safety from biological threats, including immunizations Personal behavior changes, including reproductive behavior 5 Budgeting for Public Health Practice Only 3% of all national expenditures support governmental public health functions Despite this small portion of the health care budget in the United States, public health practice provides many benefits. Imagine how many more benefits the United States might see if more money was given toward public health practice. Impact of Affordable Care Act not yet known 6 Public Health Core Functions Assessment Policy development Assurance 7 Essential Services of Public Health 1. 2. 3. 4. 5. 6. Monitor health status to identify community health problems. Diagnose and investigate health problems and hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. 7. 8. 9. 10. Link people to needed personal health services and ensure the provision of health care that is otherwise unavailable. Ensure a competent public health and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problem. 8 Levels of Health Care Services Pyramid 9 Core Competencies of Public Health Professionals 72 Competencies divided into 8 categories & 3 levels (tiers) of practice: Analytic/ assessment Policy development/ program planning Communication Cultural competency Community dimensions of practice Basic public health sciences Financial planning and management Leadership and systems thinking Quad Council Coalition developed Public Health Nursing Core Competencies 10 Quality Improvement Efforts in Public Health National Public Health Performance Standards (NPHPS) Program Accreditation Process for local and state health departments Public Health 3.0 11 Population Health (1 of 2) Original definition: “the health outcomes of a group of individuals, including the distribution of such outcomes with the group” (Kindig & Stoddard, 2003, p.1). May help describe the type of population whose health is being considered Geographic (i.e. country, state, county, city, or specific community) Clinical population of a hospital or health care system • Population Health Management 12 Population Health (2 or 2) Proposed definition: “Population Health is the health status of a defined population of individuals, including the distribution of health status within the group” (Williams, 2018). Development of information technology leading to increasing accessible population health data Healthy People 2030: https://health.gov/healthypeople County Health Rankings: https://www.countyhealthrankings.org/ 13 Public Health Nursing Scope and Standards of Public Health Nursing Practice (Quad Council, 1999 [revised 2005] Defined as “the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences” (APHAPHN, 2013). A specialty practice within nursing and public health. Often used interchangeably with community health nursing Focuses on improving population health by emphasizing prevention and attending to multiple determinants of health. Includes advocacy, policy development, and planning, which addresses issues of social justice 14 Characterizing Public Health Nursing Population-focused Community-oriented Health and prevention focused Interventions at the community and/or population level Concern for the health of all members of the population or community, particularly vulnerable populations 15 Types of Practice Focus in Nursing Individual, family, and group focused Population focused Emphasizes health protection, health promotion, and disease prevention of a population Example: Look at all children in the Head Start preschool program to evaluate if the program is achieving its goals Focus is on providing services to individuals rather than a population, while maintaining an appreciation for the values of the community Example: Developmental screening tests of children in the Head Start preschool program to evaluate each child 16 Population-Focused Nursing Practice Population (or aggregate) Subpopulations i.e. geography or special interest or circumstance i.e. high risk group withing the larger population Population-focused community-based practice Population Health Management 17 Three Key Nursing Modes in the Community (1 of 3) 1. Community-based nursing Goal: manage acute and chronic conditions Practice focus is on “illness care” of individuals and families across the life span Provide acute and chronic illness care and the provision of comprehensive, coordinated, and continuous care A setting-specific practice, care is provided where people live, work, and attend school 18 Three Key Nursing Modes in the Community (2 of 3) 2. Community-oriented nursing Goal: prevent disease and disability; promote, protect, and maintain health Practice focus is on “health care” of individuals, families, and groups in community Provide health care to promote quality of life Community diagnosis, health surveillance, monitoring, and evaluation of community and population 19 Three Key Nursing Modes in the Community (3 of 3) 3. Public health nursing practice Goal: prevent disease and disability and promote and protect the community as a whole Practice focus is on the community as a whole The effect of the community’s health status (resources) on the health of individuals, families, and groups Raise questions about the community’s overall health status and associated factors (including environmental) and working with the community to improve the population’s health status 20 Challenges for the Future Barriers to nurses specializing in leadership roles in population health initiatives. Developing population health nurse leaders Shifting public health practice to address the social determinants of health and more vigorous policy efforts to create conditions for a health population 21