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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