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Chapter 01
Population-Focused Practice: The Foundation of Specialization in
Public Health Nursing
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Objectives
1. State the mission and core functions of public health and the essential public health services.
2. Describe specialization in public health nursing and community health nursing and the practice goals of each.
3. Contrast clinical community health nursing practice with population-focused practice.
4. Describe what population-focused practice means.
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Objectives, Cont’d
5. Name barriers to acceptance of population-focused practice.
6. State key opportunities for population-focused practice.
7. Recognize quality performance standards programs in public health.
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Introduction Shift to protect and improve health of
Americans Patient Protection and Affordable Care Act
National Prevention, Health Promotion, and Public Health Council
Prevention and Public Health Fund Managed care
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Benefits of Public Health Practice Dramatic increase in life expectancy since
1900s Improved sanitation and control of infectious
diseases Population-based prevention programs Potential to prevent 70% of early deaths in
United States Enormous impact despite limited funding
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Public Health in America(Figure 1-1)
Vision: Healthy people in healthy communities
Mission: Promote physical and mental health Prevent disease, injury, and disability
Essential PH services: Assessment Policy development Assurance
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Definitions in Public Health Public health Public health core functions
Assessment Policy development Assurance
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Public Health Core Functions
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Core Competencies of Public Health Professionals
Analytic/assessment Policy development/program planning Communication Cultural competency Community dimensions of practice Basic public health sciences Financial planning and management Leadership and systems thinking
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Curriculum Content Areas for Public Health Workers
Informatics Genomics Cultural competence Community-based participatory research Policy Law Global health Ethics
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National Public Health Performance Standard Program
Set the bar for the level of performance necessary to deliver essential public health services
Four principles that guided the development Developed around the 10 essential public health
services Focus on the overall public health system rather
than on single organizations Describe an optimal level of performance Support a process of quality improvement
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Definitions of Public Health Nursing (PHN)
Scope and Standards of Public Health Nursing Practice (Quad Council, 1999)
Defined as the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences It is population-focused practice that
emphasizes the promotion of health, the prevention of disease and disability, and the creation of conditions in which all people can be healthy.
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PHN Specialty Characteristics:
Population-focused Community-oriented Health and preventive focus Interventions are made at the community or
population level There is concern for the health of all members of
the population/community, particularly vulnerable subpopulations
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Essential Areas for the Preparationof PHN Specialist (Box 1-4)
Epidemiology Biostatistics Nursing theory Management theory Change theory Economics Politics History of public
health
Issues in public health
Public health administration
Community assessment
Program planning and evaluation
Interventions at the aggregate level
Research
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Education for PHN Current
BSN graduate has basic preparation to function as a staff PHN
Master’s degree required for specialization in PHN• Then eligible to sit for
certification exam
Future BSN graduate has
basic preparation to function as a staff PHN
Doctor of Nursing Practice (DNP) will likely be required for specialization in PHN• Then eligible to sit for
certification exam
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Definitions of Population-Focused Practice
Population or Aggregate A collection of individuals who have one or more
personal or environmental characteristics in common
Members can be defined in terms of:• Geography (e.g., a county, a group of counties, or a
state)• Special interest or circumstance (e.g., children attending
a particular school) Subpopulation
Group within the larger population
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Population-Focused Practice Versus Individual-Focused Practice
Population-Focused Practice: Diagnoses, interventions, and treatments are
carried out for population or subpopulation• Levels of prevention (primary, secondary, tertiary)
Population-level decision making is different Concerned with more than one subpopulation
Individual-Focused Practice: Diagnoses, interventions, and treatments are
carried out at individual client level
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Levels of Health Care Practice
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PHN Specialists and Core PH Functions: Assessment
Participate in and provide leadership for: Assessing community needs, health status of
populations within the community, and environmental and behavioral risks
Look at trends in the health determinants Identify priority health needs Determine the adequacy of existing resources
within the community Engage in policy-development efforts
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PHN Specialists and Core PH Functions: Policy Development
Core function AND core intervention strategy Seeks to build constituencies that can help
bring about change in public policy Examples:
Development of Healthy People 2020 state objectives
National effort to control acquired immunodeficiency syndrome (AIDS)
Anti-smoking ordinances
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PHN Specialists and Core PH Functions: Assurance
Focuses on the responsibility of public health agencies to make certain that activities have been appropriately carried out to meet public health goals and plans
Includes the development of partnerships between public and private agencies
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PHN and Community Health Nursing Versus Community-Based Nursing
PHN Community-oriented, population-focused
strategies Community-based combination of population-
focused, community-oriented strategies and direct-care clinical strategies
Community health nurse Applies to all nurses practicing in the community
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Community-based nursing: provision of personal care to individuals and families in the community Community-oriented care Community-based care Three role functions of nursing practice
Master’s prepared clinical specialist
PHN and Community Health Nursing Versus Community-Based Nursing, Cont’d
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Arenas for Health Care Practice
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Roles in PHN Public health nursing administrators Staff nurses Curriculum plan to prepare staff nurse or
generalist Identification of skills and necessary
knowledge
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Challenges for the Future Barriers to specializing in PHN
Changing mindset that nursing is only at bedside Work structure and role socialization Few nurses receive graduate-level preparation in
PHN concepts and strategies Developing population-focused nurse leaders Shifting public policy