Chapter 3
Practice Settings in Public Health Nursing
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Historical
Practice Perspectives
• Visiting nurses (1877) funded by
philanthropists
– Purpose was to restore, promote health, and
prevention of disease
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Historical
Practice Perspectives
• Lillian Wald
– Public health founder
– Nurses’ Settlement House
• Henry Street Settlement
3
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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
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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
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Practice Settings
in Governmental or Official Agencies
• Commissioned Corps
– Work to advance the health of Americans and
improve delivery of services
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•
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Direct care provider
Supervisor
Consultant
Researcher and Administrator
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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
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School Nursing
• Wald established school nursing in 1902
– Proposed an experiment to decrease
absenteeism rate
– Successful experiment
• 90 percent drop in rate
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School Nursing
• School nurse challenges today:
– Communicable diseases
– Poverty
– Hunger
– Poor home and community environment
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Screenings
• Children with asthma, diabetes, obesity,
learning disabilities, violence, STDs,
addiction
• School nurses may be employed by:
– Public health agencies
– Hospitals
– Local school board
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School Nurse Role
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Care provider
Health educator
Counselor
Case manager
Health promoter
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•
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Collaborator
Healthy policy expert
Advocate
Researcher
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School Nurse Conducts
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Hearing screens
Vision screens
Scoliosis screens
Immunizations
Medication
administration
• Delegated medical
functions
• First aid
• Emergency
procedures
• Health education
12
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School-Based Centers
• Primary care centers located on school
grounds
– Nurse practitioners are primary care providers
– Provide preventive services
13
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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
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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
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Nongovernmental,
Community Agency Practice Settings
• Homeless clinics
– Safety net provider
– Receive federal funds
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Nongovernmental,
Community Agency Practice Settings
• May be sponsored by:
– Public health agencies
– Hospitals
– Community coalitions
– Academic health centers
– Universities
– Faith-based organizations
17
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Nongovernmental,
Community Agency Practice Settings
• Homeless clinics provide:
– Primary care
– Behavioral services
– Substance abuse counseling
– Case management
18
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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
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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
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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
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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
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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
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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
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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
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Workplace
• May be employed by company or
contracted independently
• Roles of the occupational health nurse:
– Clinician
– Case manager
– Coordinator
– Manager
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Workplace
• Nurse practitioner
– Corporate director
– Health promotion specialist
– Educator
– Consultant
– Researcher
27
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Home Visiting
• Home visiting
– Subspecialty of community health nursing
– Nurses provide skilled care to homebound
individuals
– Focus on restorative care
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Other Settings
• Correctional facilities
– Federal prisons
– County jails
• Community mental health centers
• Senior centers
• Adult day care
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Models of Public
Health Nursing Practice
• Minnesota Department of Health, Public
Health Section “Intervention Wheel”
– Identifies 17 interventions clustered into five
groups:
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Surveillance
Referral and follow-up
Health teaching
Collaboration
Advocacy
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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
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Other Models
• Los Angeles County Public Health Nursing
Practice Model
– Developed by public health nurses
– Blends national standards and components
– Emphasizes primary prevention
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Other Models
• Components
– Scope and Standards of Public Health
Nursing Practice
– Ten Essential Public Health Services
– Healthy People 2010 indicators
– Intervention Wheel
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Issues and Challenges
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Workforce shortage
Insufficient funds
Recruit and retain public health forces
Insufficient number of baccalaureate level
nurses
• Less than competitive salaries
34
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