Running head: NURSING’S ROLE IN POPULATION BASED ISSUES
Nursing’s Role in Population Based Issues
Margaret A. Gerulski
Ferris State University
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NURSING’S ROLE IN POPULATION BASED ISSUES
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Abstract
The overall leading cause of death in the United States is cardiovascular disease. Kent County
has been identified to have a high rate of death from cardiovascular disease. Review of the
school nurse and public health nurse in the development of a community change project that will
target the African American youth of Kent County. This project will develop interventions in
preventing cardiovascular disease. The success of this community change project will involve
identification of nursing roles that will have the greatest impact.
Key words: nursing role, school nurse, public health nurse, leadership
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Nursing’s Role in Population Based Issues
According to the CDC, cardiovascular disease was the leading cause of death in both
2009 and 2010 (CDC, 2012). Cardiovascular disease was statistically the leading cause of death
in Kent County as well as throughout the United States. The incidence of being diagnosed with
cardiovascular disease and succumbing to death is shown to be higher in the African American
population. According to Healthy People 2020, two of the leading health indicators that are high
priority public health issues are physical activity, overweight and obesity (Harkness & DeMarco,
2012). The interventions to prevent or minimize the effects of cardiovascular disease among
African American youth in Kent County related to inadequate physical activity and nutrition is
the focus for our group community change project. The Kent County Coordinated School Health
Program (KCCSHP) will be a key asset in developing this community change project. This
program is a joint effort of community entities to bring health and wellness into the schools. The
school nurses or public health nurses would be the facilitator’s in this proposal. These nurses
would help to bring education to the students in regards to incorporating physical activity and
improved nutrition to the school environment. Getting the community involved in the efforts to
improve the nutrition programs is the first step to success. Schools are already aware of the
increasing number of children who are overweight. There can be a negative effect on learning
when children have poor nutrition and lack physical activity. The KCCSHP believes that “By
promoting healthy behaviors, you can help your students to increase their capacity to learn,
reduce absences, and improve physical fitness and mental alertness” (KCCSHP, 2008). This
program focuses on schools in which at least 50% of the students qualify for free or reduced
lunches.
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Our targeted area will be the youth of Kent County; this will be an attempt to provide
preventative strategies in this age group. This selection developed after identification of
cardiovascular disease being the leading cause of death and that African American’s have a
higher incidence of developing and dying than Caucasian individuals do. The recognition that
decreased physical activity and poor nutrition has increased the incidence of obesity, leading to
increased cardiovascular disease. Therefore, actions to intervene in these areas may improve
future generations’ outcomes.
Role of School Nurse
Involvement of the school nurse in a community-based program would be important,
because of the close interaction that is allowed with students and their parents. The demand for
school health services have increased with changes in society. There are more diverse and
complex health problems of students, which require the services of a school nurse. When there
is participation by a school nurse in the developmental plan for students, there is improved
potential for achieving the goals set (American Academy of Pediatrics [AAP], 2001). It is a
great opportunity for a school nurse to collaborate with community physicians and community
organizations in the interventions for improving physical activity and nutrition in the youth of
Kent County (AAP, 2001). “The school nurse has a central management role in the
implementation of school health services programs for all children and youth in the school”
(AAP, 2001, p. 1231). The National Association of School Nurses supports that all school
nurses should have a minimum of a baccalaureate degree and a special certification or licensure
approved by the state board of nursing (AAP, 2001). Depending on community and student
population, it was one of the Healthy People 2010 objectives that there “needed to be at least one
school nurse per 750 students” (AAP, 2001, p. 1232). The focus on prevention and early
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prevention is a major part of the school health program. The school nurse can provide not only
health education, but also counseling for students. The Standards of School Nurse Practice list
the ability to use the nursing process, communicate, and collaborate within the school system and
with community health systems, and as a health educator that will be an asset in this proposed
project (Proctor, Lordi, & Zaiger, 2003).
Roles of Community and Public Health Nurses
According to the Scope and Standards of Public Health Nursing Practice (SSPHNP),
“public health nursing is the practice of promoting and protecting the health of populations using
knowledge from nursing, social, ad public health sciences” (n. d.). Prevention of disease and
disability being the goal of public health nursing allows them to focus on the creation of
programs that lead to a healthy population (SSPHNP, n. d.). The reason the community and
public health nurses would be beneficial in a population-based effort is their knowledge of the
needs of the community. Many times, there are barriers that previously identified by the public
health nurses that would aid the efforts in making the changes necessary in the population
chosen. One of the services these nurses could bring is in building and encouraging community
wide alliances to achieve the desired goal (Harness & Demark, 2012). The public health nurse
can serve as a change agent, in which they can help others realize the need for change and make
a plan to help people work together effectively (Harness & Demark, 2012). The participation of
the public health nurse in planning and implementing control and preventative measures
(Harness & Demark, 2012). Because of their involvement with members of the populationbased groups, they would have a more broad effect on the community and not just focusing on
the schools. Engagement in evidence-based practices and reviewing research findings are one of
the public health nurses expectations (Harkness & DeMarco, 2012). The public health nurse
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provides the direct services of being a caregiver, advocate, educator, counselor, collaborator, and
information broker through which change of this degree would benefit.
Important Leadership Traits
The nurse involved in the proposed community change project would have to display the
ability to communicate and collaborate with others. They would need to be responsible and
accountable for following through on planned goals and objectives of the plan for change. This
proposal would need someone who is adaptable and flexible to finding the most effective
interventions to reach the intended goal. Another leadership quality needed in this project is the
ability to gain the trust of all members involved to allow coordination of available resources.
Assuming leadership roles in nursing is essential for providing positive impact on patients. It is
not the only responsibility to provide health care to patients, but encompasses the planning,
leading, controlling and organization of the activities of all involved.
ANA Standards of Professional Practice
The ANA standards of professional practice use these nine standards – quality of
practice, education, professional practice evaluation, collegiality, collaboration, ethics, research,
resource utilization, and leadership (ANA, 2004, p. 33-45). These standards are very important
in leadership roles and direct the practice of nursing. Quality of practice uses creativity and
innovation in nursing practice to improve care delivery. Education keeps the nurse informed on
current evidence-based practices that can be implemented to the patients they meet no matter the
environment. Professional practice evaluation helps the nurse to “provide age appropriate care in
a culturally and ethnically sensitive manner” (ANA, 2004, p. 36). The standard of collegiality
helps by “contributing to an environment conductive to education and a supportive, healthy work
environment” (ANA, 2004, p.37). Collaboration involves “partnering with others to effect
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change and generate positive outcomes” (ANA, 2004, p. 38). Using ethics in practice is an
essential standard all required of all nurses. As a professional nurse, you should always be the
patient’s advocate and provide them with dignity and respect. Research and resource utilization
provide a basis for evidence-based current practice that influences “safety, effectiveness, cost
and impact on practice in the planning and delivery of nursing services” (ANA, 2004, p.42). The
role of leadership in the professional nurse is essential to provide the best care available to our
patients. Leadership involves: “Engagement in teambuilding and teamwork, creating and
maintain a healthy work environment, displaying the ability to define a clear vision, the
associated goals, and a plan to implement and measure progress; demonstration of a commitment
to continuous, lifelong learning for self and others; teaching others through mentoring and other
strategies (ANA, 2004, p. 42, 43).
Analysis
It would be necessary for the professional nurse to follow the mentioned ANA standards
of professional practice. These two roles are very similar except in the surroundings in which
they practice. The school nurse is exposed to the community in a different way than the public
health nurse. They both can have the same effect of society. The evaluation of the nursing roles
that were chosen to facilitate this community-based change project would need to possess all of
the leadership qualities that were described. Both of these nursing roles would need to be able to
advocate for the suggested change. Their abilities to communicate the proposed interventions to
attain the planned goal would be essential in the role of both the school nurse and public health
nurse. Public health nurses have access to the entire population and focus on primary
prevention. Through their leadership abilities, both nursing roles provide “education and
information to affect the values, beliefs, attitudes and behaviors of the families and individuals
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they serve” (Guiterrez, n. d.). They are able to affect laws and policies that influence health
through their interactions with community groups and government organizations (Guiterrez, n.
d.). After reviewing the Standards of School Nurse Practice, they are directed towards utilization
of decision-making and problem solving (Proctor, Lordi, & Zaiger, 2003).
The standards are strong leadership indicators that would be a valuable asset in the pursuit of the
proposed community change project. The role of management is not uncommon to the school
nurse because most school nurses transition out of a clinical nursing role, which requires
leadership and management. The goal of a school nurse is the management of screening and
health education programs, which is a strength of this role in the community based proposal that
is being suggested.
Reflection
After writing this paper there are many qualities and skills necessary to fulfill these roles.
I do feel that I possess several of these qualities and skills, such as my leadership,
communication and collaboration skills. My previous nursing experience has prepared me to be
able to have an impact on this community project. Having had the experience of leading the
patient satisfaction team and interacting with various departments within the hospital helped me
to develop some networking that would be essential in this project. I think that my lack of
experience and knowledge of public health nursing would limit my ability to be as effective.
Having to build relationships with other organizations to which I am not familiar with can be
very intimidating. I would need to have a relationship with someone who had contacts with
these outside organizations to be successful in this area. The advancement of my education has
helped to lead me on the path to succeeding in this area by increasing my knowledge of public
health issues and interventions available.
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References
American Academy of Pediatrics. (2001). The role of the school nurse in providing school
health services. Pediatrics, 108(5), p. p. 1231-1232.
Center for Disease Control (CDC). Retrieved February 20, 2012 from:
http://www.cdc.gov/nchs/fastats/lcod.htm
Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing practice:
Evidence for practice. Philadelphia, PA: Wolters Kluwer/Lippincott, Williams &
Wilkins.
Kent County Coordinated School Health Program (KCCSHP). (2008). Retrieved February 20,
2012 from: http://kccshp.weebly.com/uploads/2/7/6/1/276118/2008_kccshp_brochure.pdf
Guiterrez, C. (n. d.) Public health nursing and standards of practice. Retrieved February 24, 2012
from: http://www.ehow.com/facts_7374948_public-health-nursing-standardspractice.html
Scope and Standards of Public Health Nursing Practice. (n. d.) Retrieved February 24, 2012
from: http://www.ct.gov/dph/lib/dph/Scope_Standards_PHN.pdf
Proctor, S., Lordi, S. L., & Zaiger, D. (2003). School nursing practice: Roles and standards.
Retrieved February 20, 2012 from: http://www.eric.ed.gov/PDFS/ED361612.pdf