December 12, 2013
Middlesex Fire Academy
Sayreville, NJ
The Minnesota Model aka The
Wheel of Interventions: A Best
Practice Model for Public
Health Nursing in New Jersey?
Susan (Sue) Strohschein, MS, RN, APHN-BC
stroh025@umn.edu
651-528-8987
Charles-Edward
Amory Winslow
1877-1957
• Bacteriologist
• Founder of Yale
School of Public
Health (1915)
• Great admirer of
public health
nurses
ASTDN (APHN)
Report on a Public Health Nurse to Population Ratio
October 2008
Red Lake, Boise Fort
Grand
Portage
Lower
&
Upper
Sioux
Prairie Island
Red Wedge
Green Wedge
Blue Wedge
Orange Wedge
Yellow Wedge
Characteristics of Population-Based Practice
•Focuses on entire populations
•Grounded in community assessment
•Considers broad determinants of health
•Focuses on prevention
•Utilizes multiple levels of intervention
Population
A collection of individuals who
have one or more personal or
environmental characteristics
in common
Focuses on entire populations, not
just ill or high risk individuals who
present for care
Populations
Population at risk:
Population with a
common identified
risk factor or riskexposure that poses
a threat to health
Population of interest:
Population that is
essentially healthy but
who could improve
factors which promote
health
Characteristics of Population-Based Practice
•Focuses on entire populations
•Grounded in community assessment
•Considers broad determinants of health
•Focuses on prevention
•Utilizes multiple levels of intervention
COMMUNITY ASSESSMENT
Identifies a community’s unique :
 health status
 health problems
 populations at risk
 risk/protective factors
 resources and assets
 liabilities
How important is this issue for
your community?
Prioritization
Characteristics of Population-Based Practice
•Focuses on entire populations
•Grounded in community assessment
•Considers broad determinants of health
•Focuses on prevention
•Utilizes multiple levels of intervention
Determinants of Health
•Health services
•Personal health practices & coping skills
•Physical environments
•Employment and working conditions
•Income and social status
•Social support networks
•Education
•Healthy child development
Schroeder, 2007
Characteristics of Population-Based Practice
•Focuses on entire populations
•Grounded in community assessment
•Considers broad determinants of health
•Focuses on prevention
•Utilizes multiple levels of intervention
Levels of Prevention
Prevention
Framework
Primary
Secondary
Tertiary
Purpose: Keep
events from occuring
in the first place
Purpose: Early detection
and prompt treatment
Purpose: Limiting effects of
an event after it has occured
Health
Promotion
Health
Protection
Screening
Rehabilitation &
Remediation
Characteristics of Population-Based Practice
•Focuses on entire populations
•Grounded in community assessment
•Considers broad determinants of health
•Focuses on prevention
•Utilizes multiple levels of intervention
Population-based communityfocused interventions...
change community norms, attitudes,
awareness, practices, and
behaviors
Community-focused
Systems-focused
Population-based systemsfocused interventions
change organizations, policies, laws,
and structures
Individual/family-focused
Population-based individual-focused
interventions...
change knowledge, attitudes, beliefs,
skills, practices, and behaviors in
individuals, either singly or in
families, classes,
or groups
PHN Settings
• Clinics
• Coalitions
• Communitiesat-large
 Community agencies
 Correctional facilities
 Daycares
• Group Homes
• Homes
• Hospitals
• Local & State
Government
• Public Health
Nursing clinics
 Schools
 Shelters
 Worksites
Interventions are ...
Actions taken on behalf of
communities
the individuals and families that comprise
those communities
the systems that affect the health of those
communities
which impact health status
PHN Interventions
 Surveillance
 Disease & Health






Investigation
Screening
Outreach
Case Finding
Referral & Follow-up
Case Management
Delegated Functions









Health Teaching
Counseling
Consultation
Collaboration
Community
Organizing
Coalition Building
Advocacy
Social Marketing
Policy Development &
Enforcement
Surveillance
Disease and Other Health Event Investigation
Outreach
Screening
Screening – Community Level
Screening – Systems Level
Case Finding
GREEN WEDGE
Case Management
Delegated Functions
BLUE WEDGE
Health Teaching-Individual Level
Health Teaching-Community Level
Counseling
Consultation
Consultation – Systems Level
Consultation –Community Level
Consultation – Individual Level
ORANGE WEDGE
THE THREE C’S OF
COLLECTIVE ACTION
COLLABORATION
COALITION BUILDING
COMMUNITY ORGANIZING
Collaboration
Coalition Building
Community Organizing
YELLOW WEDGE
Advocacy
Social Marketing
Policy Development and Enforcement
Policy Enforcement – Individual Level
Policy Enforcement – Systems Level
Applications
Public Health Nursing Practice Model*
3. Mobilize Community
4. Develop Policies
& Plans
C
D
5. Inform, Educate,
Empower
6. Enforce Laws
7. Link to/ Provide
Care
8. Assure
Competent
Workforce
2. Diagnose & Investigate
B
1. Monitor Health
9. Evaluate Services
10. Research A
References:
(A)Public Health Functions Steering Committee. (1994, Fall). Public Health in America. Retrieved May 7, 2001, from the World Wide Web: http://health.gov/phfunctions/public.htm
(B) Quad Council of Public Health Nursing Organizations. (1999). Scope and Standards of Public Health Nursing Practice. Washington D.C.: American Nurses Association.
(C)Minnesota Department of Health, Public Health Nursing Section. (2000). Public Health Nursing Practice for the 21st Century: National Satellite Learning Conference; Competency
Development in Population-based Practice October 5, November 2, December 7, 2000 . St. Paul, MN: Minnesota Department of Health, Public Health Nursing Section. Retrieved May 7,
2001, from the World Wide Web: http://www.health.state.mn.us/divs/chs/phn/material.htm
(D) U.S. Department of Health and Human Services. (2000). Healthy People 2010. (Vol. 1). McLean, VA: International Medical Publishing, Inc.
*Created by Los Angeles County DHS, Public Health Nursing with input from CCLHDND-Southern Region.
This model serves as the basis for the CCLHDND California PHN Practice Model (05-2002).
© 2002 Los Angeles County DHS Public Health Nursing
http://www.maphn.org/Resources/Documents/MAPHNLeadershipGuide2005.pdf
Shiprock Service Unit
Community Health Services
Public Health Nursing
Queensland Health
(Australia)
Community Health Nursing
Competency and Skills (2009)
Townsville Health
Service District
http://www.publichealthne.org/phn_section.htm
http://pphtc.org/training/courselist.htm
http://www.sph.umn.edu/ce/tools/wheel/
http://www.people.vcu.edu/~elmiles/interventions/
Module C2: Application of a Public Health
Framework to the health of young people.pdf
http://www.unil.ch/euteach/page85555.html
Institute of
Community
Health
Nursing
http://www.ichn.ie/about/ichnconference-2013
http://www.health.state.mn.us/divs/opi/cd/phn/wheel.html
In the Literature
• Translated into numerous languages: Spanish,
Portuguese, Norwegian, Greek, Turkish
• First article published in Public Health Nursing in
1998
• Manual began availability online from MDH in 2001
• Sept/Oct 2004 issue Public Health Nursing published
Parts I & II
• Articles cited by others more than 30 times
• Served as the basis of at least one doctoral thesis
(Australia) and at least one masters’ thesis (Greece)
https://cpheo1.sph.umn.edu/MCLPH/InterventionWheel/index.asp
Keller, LO., Strohschein, S., Schaffer, MA. (2011)
Cornerstones of public health nursing. Public
Health Nursing 28(3):249-60
Glavin, K., Shaffer, MA. (2013) A comparison of
the cornerstones of public health nursing in
Norway and in the United States. Public Health
Nursing (in press)
Our goal as a public health nurse is to reflect community needs
We're grounded in social justice and compassion for all indeed
We encompass mental, physical , emotional , social, and
spiritual health
We'll help you when you're down and out regardless of your
wealth
We use the Intervention Wheel to help our clients out
Let us pause to show you what it's all about
Following we present possible public health parodies
That use the Wheel to intervene and solve the problem with
ease