Chapter 3 Practice Settings in Public Health Nursing Copyright © 2008 Delmar. All rights reserved. Historical Practice Perspectives • Visiting nurses (1877) funded by philanthropists – Purpose was to restore, promote health, and prevention of disease 2 Copyright © 2008 Delmar. All rights reserved. Historical Practice Perspectives • Lillian Wald – Public health founder – Nurses’ Settlement House • Henry Street Settlement 3 Copyright © 2008 Delmar. All rights reserved. Practice Settings in Governmental or Official Agencies • Public Health Service (PHS) 1798 – U.S. Department of Health and Human Services (HHS) • Protects the health of Americans • Provides health services for those who lack resources 4 Copyright © 2008 Delmar. All rights reserved. Practice Settings in Governmental or Official Agencies • Made up of 11 operating division that fall into two categories – Public Health Service Operating Division – Human Services Operating Division • Nurses may work in any division 5 Copyright © 2008 Delmar. All rights reserved. Practice Settings in Governmental or Official Agencies • Commissioned Corps – Work to advance the health of Americans and improve delivery of services • • • • Direct care provider Supervisor Consultant Researcher and Administrator 6 Copyright © 2008 Delmar. All rights reserved. State and Local Public Health Agencies • State health departments perform needs assessment of the population – Identify Healthy People 2010 objectives • Local health agencies – Provide direct personal services for those dependent on government assistance 7 Copyright © 2008 Delmar. All rights reserved. School Nursing • Wald established school nursing in 1902 – Proposed an experiment to decrease absenteeism rate – Successful experiment • 90 percent drop in rate 8 Copyright © 2008 Delmar. All rights reserved. School Nursing • School nurse challenges today: – Communicable diseases – Poverty – Hunger – Poor home and community environment 9 Copyright © 2008 Delmar. All rights reserved. Screenings • Children with asthma, diabetes, obesity, learning disabilities, violence, STDs, addiction • School nurses may be employed by: – Public health agencies – Hospitals – Local school board 10 Copyright © 2008 Delmar. All rights reserved. School Nurse Role • • • • • Care provider Health educator Counselor Case manager Health promoter • • • • Collaborator Healthy policy expert Advocate Researcher 11 Copyright © 2008 Delmar. All rights reserved. School Nurse Conducts • • • • • Hearing screens Vision screens Scoliosis screens Immunizations Medication administration • Delegated medical functions • First aid • Emergency procedures • Health education 12 Copyright © 2008 Delmar. All rights reserved. School-Based Centers • Primary care centers located on school grounds – Nurse practitioners are primary care providers – Provide preventive services 13 Copyright © 2008 Delmar. All rights reserved. Nongovernmental, Community Agency Practice Settings • Primary care centers – Primary health care – Primary care • Community health centers – Safety net provider – Partially funded by federal grant program 14 Copyright © 2008 Delmar. All rights reserved. Nongovernmental, Community Agency Practice Settings • Improve access to health services to medically underserved – Required to serve all residents – Offer sliding scale fee – Governed by board of members 15 Copyright © 2008 Delmar. All rights reserved. Nongovernmental, Community Agency Practice Settings • Homeless clinics – Safety net provider – Receive federal funds 16 Copyright © 2008 Delmar. All rights reserved. Nongovernmental, Community Agency Practice Settings • May be sponsored by: – Public health agencies – Hospitals – Community coalitions – Academic health centers – Universities – Faith-based organizations 17 Copyright © 2008 Delmar. All rights reserved. Nongovernmental, Community Agency Practice Settings • Homeless clinics provide: – Primary care – Behavioral services – Substance abuse counseling – Case management 18 Copyright © 2008 Delmar. All rights reserved. Rural Health Clinics (RHC) • Rural Health Clinic Services Act (1977) – Safety net provider, increases accessibility, and availability to primary care services – Allowed RHC to receive cost based Medicare and Medicaid reimbursement – Assist with delivery of personal care services for prevention, and acute and chronic services 19 Copyright © 2008 Delmar. All rights reserved. Rural Health Clinics (RHC) • Rural populations have an older population – Higher rate of chronic illness – Higher rate of poor health behaviors • Challenges – Obtaining and retaining providers 20 Copyright © 2008 Delmar. All rights reserved. Migrant Health Centers • Safety net provider • Operated by nonprofit agencies to: – Improve accessibility to culturally linguistic primary care – Improve availability to culturally linguistic primary care 21 Copyright © 2008 Delmar. All rights reserved. Nurse Managed Health Centers • Safety net provider when primary mission is to provide accessible health services • Managed and directed by nurses • Challenges – Sufficient resources – Revenue for expenditures 22 Copyright © 2008 Delmar. All rights reserved. Faith-Based Organizations • Made up of those who share a common spiritual or religious faith • May take place in: – Churches – Synagogues/Cathedrals – Temples/Mosques – Other buildings used by faith community 23 Copyright © 2008 Delmar. All rights reserved. Faith-Based Organizations • Parish nurses – Specialty practice – Scope and standards of practice for parish nurses – Provide holistic care within the context of the religious community 24 Copyright © 2008 Delmar. All rights reserved. Workplace • Vermont Marble Company 1900s – Coal Miners, WWII • Various occupational settings today • Specialty practice that focuses on: – Health promotion – Disease and injury prevention – Restoration of health and safe environment 25 Copyright © 2008 Delmar. All rights reserved. Workplace • May be employed by company or contracted independently • Roles of the occupational health nurse: – Clinician – Case manager – Coordinator – Manager 26 Copyright © 2008 Delmar. All rights reserved. Workplace • Nurse practitioner – Corporate director – Health promotion specialist – Educator – Consultant – Researcher 27 Copyright © 2008 Delmar. All rights reserved. Home Visiting • Home visiting – Subspecialty of community health nursing – Nurses provide skilled care to homebound individuals – Focus on restorative care 28 Copyright © 2008 Delmar. All rights reserved. Other Settings • Correctional facilities – Federal prisons – County jails • Community mental health centers • Senior centers • Adult day care 29 Copyright © 2008 Delmar. All rights reserved. Models of Public Health Nursing Practice • Minnesota Department of Health, Public Health Section “Intervention Wheel” – Identifies 17 interventions clustered into five groups: • • • • • Surveillance Referral and follow-up Health teaching Collaboration Advocacy 30 Copyright © 2008 Delmar. All rights reserved. Other Models • State and Territorial Directors of Nursing Public Health Nursing Practice Model – Developed in 1994 by Public Health Functions Steering Committee – Model links core public health functions 31 Copyright © 2008 Delmar. All rights reserved. Other Models • Los Angeles County Public Health Nursing Practice Model – Developed by public health nurses – Blends national standards and components – Emphasizes primary prevention 32 Copyright © 2008 Delmar. All rights reserved. Other Models • Components – Scope and Standards of Public Health Nursing Practice – Ten Essential Public Health Services – Healthy People 2010 indicators – Intervention Wheel 33 Copyright © 2008 Delmar. All rights reserved. Issues and Challenges • • • • Workforce shortage Insufficient funds Recruit and retain public health forces Insufficient number of baccalaureate level nurses • Less than competitive salaries 34 Copyright © 2008 Delmar. All rights reserved.