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
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Question #1
Is the following statement true or false?
Healthcare disparities are social conditions in which people
live and work.
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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.
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Major Changes in Healthcare in the 21st
Century
 Development of patient/client-centered care
 Increased use of technology
 Increased personal responsibility
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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
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Healthcare Changes in the 21st Century
#2
 Healthcare disparities—differences in healthcare and
health outcomes experienced by one population
compared with another
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Role of Government in Healthcare
 Three core functions are as follows:
o Assesses healthcare problems
o Intervenes by developing relevant healthcare policy
that provides access to services
o Ensures that services are delivered and outcomes are
achieved
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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
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Question #2
 What is one of the core functions of the role of
government in healthcare?
A. Provide affordable health insurance coverage
B. Improve access to primary care
C. Lower costs
D. Assess healthcare problems
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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.
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Patient/Client-Centered Care
 Cultural traditions
 Personal preferences
 Values
 Families
 Lifestyles
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Technology
 Rapidly advancing forms of technology are dramatically
improving lives.
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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
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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
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Personal Responsibility for Health
 Active participation in one’s own health through
education and lifestyle changes
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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
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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.
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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.
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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.
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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.
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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.
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Competencies for Public Health Nursing
Practice
 Three tiers of practice
 Competencies associated with that level of practice
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Public Health Intervention Wheel
 17 interventions
 Actions taken on behalf of individuals, families,
communities, and systems to protect or improve health
status
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Public Health Nursing Interventions
 Population-based model
 Applied to individuals, families, communities, or within
systems
 Focuses upon prevention
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Education for Public Health Nursing
Practice
 Public health nursing practice
o Baccalaureate degree in nursing (BS or BSN)
o Generalist master’s degree as clinical nurse leader
(CNL)
 Public health nursing specialists in population health
o MSN
o MPH
o MSN/MPH
o Doctoral degrees: PhD, DNP, DrPH
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Roots of Public Health Nursing
 Early civilization
 Middle Ages
 English Poor Law
 Variety of reforms in 1800s
 Victorian times
 District nursing
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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
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Public Health Initiatives in Early America
early 1900’s
founder of public health
nursing
the Henry Street
Settlement
focus on MCH education
VNSNY
Lillian Wald
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Public Health Initiatives in the 20th
Century
 Mary Breckinridge
 Early 20th-century federal healthcare initiatives
 Public health in the second half of the century
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The First Decade of the 21st Century
 Department of Homeland Security: fosters an allhazards, 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
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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.
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Evidence-Based Public Health
 Public health endeavor with judicious use of evidence
derived from a broad variety of science and social
science research
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Epidemiology
 Science of prevention
 Knowledge of the natural history of diseases and the
identified (risk) factors that increase a person’s
susceptibility to illness
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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
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Challenges for Public Health Nursing in
the 21st Century #2
 Responding to emergencies, disasters, and terrorism
 Responding to the global environment
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