COMMUNITY EXAM 1
Appendix F1: Essential Elements of Public Health Nursing Appendix
· Essential element 1: conduct community assessment: systematically collecting, assembling, analyzing, and making available health-related data for the purpose of identifying and responding to community- and state-level public health concerns and conducting epidemiologic and other population-based studies. · Essential element 2: preventing and controlling epidemics: monitoring disease trends and investigating and containing diseases and injuries. · Essential element 3: providing a safe and healthy environment: maintaining clean and safe air, water, food, and facilities both in the community and in the home environment. · Essential element 4: measuring performance effectiveness, and outcomes of health services: monitoring health care providers and the health care system to identify gaps in service, deteriorating health status indicators, effectiveness of interventions, and accessibility and quality of personal and population-wide health services. · Essential element 5: promoting healthy lifestyles: providing health education to individuals, families, and communities. · Essential element 6: providing targeted outreach and forming partnerships: ensuring access to services, including those that lead to self-sufficiency, for all vulnerable populations and ensuring the development of culturally appropriate care. · Essential element 7: providing personal health care services: providing targeted direct services to high-risk populations. · Essential element 8: conducting research and innovation: discovering and applying improved health care delivery mechanisms and clinical interventions. · Essential element 9: mobilizing the community for action: providing leadership and initiating collaboration
What are school health services and coordinated school health programs? How do these programs complement community and public health programs?
·· Federal school health programs: developed in 1987 after the CDC began funding schools for HIV-prevention education programs. By 1992 this educational system was so successful that it was expanded t include school health programs to teach children prevention of other chronic illnesses. These include disease caused in part by risk factors such as poor diet, lack of exercise, and smoking. The funding has paid for the development of health education plans of study or curricula, which include policies, guidelines, and training for these health programs. The states then use these course to teach the children. The schools are actively involved in helping the children practice problem solving, communication, other life skills so they can reduce their risk factors. · School-based health programs: family-centered, community-based clinics run within schools. These clinics give expanded health services, including mental health and dental care. The SBHCs can range in size from small to large, some school clinics are open to the community only during the school ear and others are open 24 hours a day all year round. School-linked program, which is coordinated by the school but has community ties. There is collaboration between the county health department, the local university nursing school and other private health care provider to give primary, secondary and tertiary nursing care.
Appendix F.2: American Public Health Association Definition of Public Health Nursing
American Public Health Association: a national organization founded in 1872 to facilitate interdisciplinary efforts and to promote the health of the public. Public health nursing: the practice of protecting and promoting the health of populations using knowledge from nursing, social, and public health sciences
Appendix F.4: The Health Insurance Portability and Accountability Act (HIPAA): What Does it Mean for Public Health Nurses?
Health Insurance Portability and Accountability Act of 1996 (HIPAA): federal law requiring confidentiality and privacy concerning health care records. What Does it Mean for Public Health Nurses? Although it does place many limits on the sharing of protected health information, the Privacy Rule allows for the existing practice of sharing protected health information with public health authorities that are authorized by law to collect or receive such information to aid them in their mission of protecting the health of the public.
The definition of evidence-based nursing and the uses of evidence in the provision of CH nursing care?
- Evidence-based nursing: An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served. - EBP: Includes the best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise and evidence form community leaders - Evidence based public health: Public health endeavor in which there is an informed, explicit and judicious use of evidence that has been derived from any of a variety science and social science research and evaluation methods -Seven-step EBP process: Cultivating a spirit of inquiry; Asking clinical questions; Searching for best evidence; Critically appraising evidence; Integrating evidence with expertise and client preferences and values; Evaluating outcomes; Disseminating EBP results - Approaches to EBP: systematic review, meta-analysis, integrative review, and narrative review - Intervention Wheel: an example of a result of EBP; a population-based practice model for public health nursing that consists of 3 levels of practice at the community, systems, and individual/family levels and 17 public health interventions for improving population health. - EBP model that ensure the community's perspective is included: community development model - Most appropriate approach to establishing evidence in public health: case-control studies - Barriers to adopting EBP in the community setting: miscommunication about implementation; inferior quality of evidence; inability to assess/use evidence; unwillingness to fund research/ make decisions; nurse's ability to make clinical decisions; resources, reluctance to accept, & resistance to change
What is genomics?
- Genomics is the study of all of a person's genes, including their interaction with one another as well as the interaction of a person's genes with the environment. - Refers to the study of individual genes in order to understand the structure of the genome, including the mapping of genes and sequencing the DNA.
How does public health and public health nursing differ at the local, state, and national levels?
- Local public health agencies: the agency that is responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community. - Local public health agencies responsibilities: implementing and enforcing local public health codes and ordinances and providing essential public health services to the community. - State public health agencies responsibilities: monitoring health status and enforcing laws and regulations that protect and improve the public's health. They receive funding from federal agencies to implement public health initiatives. - Federal public health agencies responsibilities: develop regulations, provide funding to state and territorial health agencies, survey nation's health status and needs, set practices and standards, provide expertise that facilitates EBP, coordinate activities across state lines, and support research. - American Nurses Association: the national professional association of registered nurses in the United States, founded in 1896. - American Public Health Association: a national organization founded in 1872 to facilitate interdisciplinary efforts and to promote the health of the public. - American Red Cross: a national organization that seeks to reduce human suffering through various health, safety, and disaster relief programs in affiliation with the International Committee of the Red Cross.
What are the essential roles of public health nursing?
- Public health nursing: the practice of protecting and promoting the health of populations using knowledge from nursing, social, and public health sciences - The synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of practice is the community as a whole. - Public health nurse roles: advocate, case manager, referral source, counselor, educator, outreach worker, disease surveillance expert, community mobilizer, and disaster responder
Why is genomics important?
- The understanding of the fundamental role genetics and genomics play in shaping the practice of public health nurses in the twenty-first century is in its early stages, although the rate of new knowledge is incredible. - Genomics plays a role in nine of the ten leading causes of death in the United Sates, most notably chronic diseases such as cancer and heart disease. - Disorders that are influenced by multiple factors including genetics/genomics, environment, lifestyle, and other factors are considered to be multi-factorial. - The use of genomics and how it relates to drug treatment will enable personalized health care and medicine to be tailored to each person's needs; health, therefore, can be predictive and preventive in nature. - The field of genetics/genomics is growing rapidly and will require nurses to continue to learn and to be aware of advances in research in this area. - Genomics affects individuals, families, and communities.
In what ways can nurses integrate genomics in nursing practice?
-Be knowledgeable of genetics and genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness. Create three-generation family health history. Assess client knowledge. Create care plan. -Identify clients who may benefit from specific genetic services. ID credible sources, info, and services. Identifies ethical, ethnic/ancestral, cultural, religious, legal, fiscal, and societal issues related to genetic and genomic information and technologies. -Referral- Facilitates referral for specialized genetic and genomic services for clients as needed. -Provision of Education, Care, and Support- Provides clients with interpretation of selective genetic and genomic information or services.
How does the nursing process relate to the practice of environmental health?
-follow the nursing process and note the environmental aspects of the problem in every step of the nursing process (e.g., in goal setting, should include outcome measures that relate to mitigation and elimination of the environmental factors.) - a concept that may include dynamic factors such as air, water, soil, and food, as well as temperature, humidity, and wind. - Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments.
How does the environment influence human health and disease?
All that is asked ternal to a given host or agent and that is influenced by and influences the host and/or agent - extra factors. -The environment influences human health in many ways - through exposures to physical, chemical and biological risk factors, and through related changes in behavior in response to those factors. According to the WHO, 13 million deaths annually are due to preventable environmental causes.
Appendix F3: American Nurses Association Scope and Standards of Practice for Public Health Nursing
American Nurses Association Scope & Standards of Practice for Public Health Nursing STANDARDS OF CARE Standard 1. Assessment The public health nurse collects comprehensive data pertinent to the health status of populations. Standard 2. Population Diagnosis and Priorities The public health nurse analyses the assessment data to determine the diagnoses or issues. Standard 3. Outcomes Identification The public health nurse identifies expected outcomes for a plan specific to the population or situation. Standard 4. Planning The public health nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. Standard 5. Implementation The public health nurse implements the identified plan. Standard 6. Evaluation. The public health nurse evaluates progress toward the attainment of outcomes.. STANDARDS OF PROFESSIONAL PERFORMANCE Standard 7. Ethics The public health nurse practices ethically. Standard 8. Education The public health nurse attains knowledge and competency that reflect current practice. Standard 9. Evidence-Based Practice and Research The public health nurse integrates evidence and research findings into practice. Standard 10. Quality of Practice The public health nurse contributes to quality nursing practice. Standard 11. Communication The public health nurse communicates effectively in a variety of formats in all areas of practice. Standard 12. Leadership The public health nurse demonstrates leadership in the professional practice setting and the profession Standard 13. Collaboration The public health nurse collaborates with the population and others in the conduct of nursing practice. Standard 14. Professional Practice Evaluation The public health nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. Standard 15. Resource Utilization The public health nurse utilizes appropriate resources to plan and provide nursing and public health services that are safe, effective, and financially responsible. Standard 16. Environmental Health The public health nurse practices in an environmentally safe, fair, and just manner.
How can public health nurses form collaborative community partnerships for community and public health nursing? What are the benefits of partnering with the community?
As an advocate, the public health nurse collects, monitors, and analyzes data and works with the client to identify and prioritize needed services. At the community and population levels public health nurses promoted healthy behaviors, safe water and war and sanitation. They advocate for healthy policies at the local, state and federal levels that will develop healthy communities.
What is the current Public Health system in the US?
Broad range of services, including basic health services, family planning, clean water supply, sanitation, immunization and nutrition education Programs designed to be affordable for the recipients of the care and the governments that provide them. The public health system is mandated through laws that are developed at the national, state, or local level. Examples of public health laws instituted to protect the health of the community include law mandating immunizations for all children entering kindergarten and a law requiring constant monitoring of the local water supply. The public health system is organized into many levels in the federal, state, and local systems. At the local level, health departments provide care that is mandated by state and federal regulation.
How does the nursing process compare with or contrast to community-oriented nursing practice?
Community-Oriented Nursing Practice is a philosophy of nursing service delivery that involves the generalist or specialist public health and community health nurse providing "health care" through community diagnosis and investigation of major health and environmental problems, health surveillance, and monitoring and evaluation of community and population health status for the purposes of preventing disease and disability and promoting, protecting, and maintaining "health" in order to create conditions in which people can be healthy. Public Health Nursing Practice is the synthesis of nursing theory and public health theory applied to promoting and preserving health of populations. The focus of practice is the community as a whole and the effect of the community's health status (resources) on the health of individuals, families, and groups. Care is provided within the context of preventing disease and disability and promoting and protecting the health of the community as a whole. Public Health Nursing is population focused, which means that the population is the center of interest for the public health nurse. Community Health Nurse is a term that is used interchangeably with Public Health Nurse. Community-Based Nursing Practice is a setting-specific practice whereby care is provided for "sick" individuals and families where they live, work, and go to school. The emphasis of practice is acute and chronic care and the provision of comprehensive, coordinated, and continuous services. Nurses who deliver community-based care are generalists or specialists in maternal-infant, pediatric, adult, or psychiatric-mental health nursing.
How does the public health or community health nurse develop a community-oriented nursing care plan?
Community-oriented nursing versus community-based nursing. Public health should include concern for all populations within the community, whether free living or institutionalized. Not all health care providers are population oriented, although they may contribute to the community's health. -Public health nurses are concerned with the health of the entire population as a whole regardless if they do or do not have access to the healthcare system. --- Public health nurses must move into positions in which the can influence policy formation. - Community-oriented nurses operate from a health care focus based on an understanding of broad community needs. They focus on health promotion, health education, disease prevention, and coordination of health care for members of the community to the benefit of the entire community. They also work to identify high-risk groups in the community. --- Community-oriented nursing emphasizes on the prevention of disease and disability. -- A nurse investigating an environmental health problems caused by contaminates. - Community-based nurses are oriented toward managing acute or chronic conditions and promoting self-care among individual clients and families. The nursing care is family centered. Throughout care delivery, the nurse teaches and counsels clients so that they can more fully develop their own ways of taking care of themselves. --- Community-based nursing practice is a setting specific practice, where care is provided for families where they live, work, and go to school. Its focus is on acute and chronic care and the delivery of services. -- A nurse conducting hearing tests on children within a school.
How does one define community, community client, community health, and partnership for health?
Community: At its simplest, a community is a group of people that share something in common, such as geographic location, interests, or values. The World Health Organization defines community as "a group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time". In most definitions, the community includes three factors: people, place, and function. Community client: The community is the client only when the nursing focus is on the collective or common good of the population instead of on individual health. Population-centered practice seeks healthful change for the whole community's benefit Community health: Community health is reflected in the health behaviors and subsequent outcomes of its residents and also by the ability of the community as a system to support healthy individuals Partnership for health: Partnering with community members is a key element of a successful community health program or intervention. Involving community members not only in the data collection process, but in all phases of the assessment, ensures that the data collected are more accurate and more relevant to the concerns of the community. Partnerships also promote community members' investment in the success of the assessment and in the resulting projects to improve community health. Therefore, successful strategies for improving community health must include community partnerships as the basic means or key for improvement.
How effective is the US Primary Health Care system?
Definition of Primary Health Care System: Primary health care (PHC), the goal of the integration of public health and primary care, includes a comprehensive range of services including public health and preventive, diagnostic, therapeutic, and rehabilitative services. This system is composed of public health agencies, community-based agencies and primary care clinics, and health care providers. From a conceptual point of view, PHC is essential care made universally accessible to individuals, families, and the community. Health care is made available to them with their full participation and is provided at a cost that the community and country can afford. This care is not uniformly available and accessible to all people in many countries including the United States. As a WHO member nation, the United States has endorsed primary health care as a strategy for achieving the goal of "Health for All in the 21st Century."
What are the trends (i.e. Costs, Access, Quality) affecting the health care system?
Demographic trends: Baby boomer impact: most reached 65 by 2011, and live longer than previous generation. Impact on Medicare is expected to be enormous. People >65 to double between 2000 and 2030, equal to 20% of total population. Costs: In the years between 2010 and 2019, national health spending is expected to grow at an average annual rate of 6.1%, reaching $4.5 trillion by 2019, for a share of approximately 19.3% of the GDP. The largest share of health care expenditures goes to pay for hospital care, with physician services being the next largest item. The amount of money that has gone to pay for public health services is much lower than for the other categories of expenditures. Other significant drivers of the increasingly high cost of health care include prescription drugs, technology, and chronic and degenerative disease. Increase Medicare due to increase enrollments of the baby boomers. Although workers' salaries have not kept pace, employer-sponsored insurance premiums have grown 119% since 1999 (Kaiser Family Foundation, 2009a), and the inability of workers to pay this increased cost has led to a rise in the percentage of working families who are uninsured. Access: Another significant problem is poor access to health care. The American health care system is described as a two-class system: private and public. People with insurance or those who can personally pay for health care are viewed as receiving superior care; those who receive lower quality care are (1) those whose only source of care depends on public funds or (2) the working poor, who do not qualify for public funds either because they make too much money to qualify or because they are illegal immigrants. In 2012, the total number of uninsured persons in the United States was 48 million. There is a safety net for the uninsured or under-insured. There are more than 1300 federally funded community health centers throughout the country. Federally funded community health centers provide a broad range of health and social services, using nurse practitioners and RNs, physician assistants, physicians, social workers, and dentists. Community health centers serve primarily in medically under-served areas, which can be rural or urban. These centers serve people of all ages, races, and ethnicities, with or without health insurance. Quality: Main issue is quality of health care. 98,000 deaths a year could be attributed to preventable medical errors. Some of the untoward events categorized in this report included adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint related injuries or death, falls, burns, pressure ulcers, and mistaken client identities. It was further determined that high rates of errors with serious consequences were most likely to occur in intensive care units, operating rooms, and emergency departments. Beyond the cost in human lives, preventable medical errors result in the loss of several billions of dollars annually in hospitals nationwide. Categories of error include diagnostic, treatment, and prevention of errors as well as failure of communication, equipment failure, and other system failures. The culture of quality improvement and safety has made providers and consumers more conscious of safety, but medical errors and untoward events continue to occur. As a means to improve consumer awareness of hospital quality, the Centers for Medicare and Medicaid Services (CMS) began publishing a database of hospital quality measures, Hospital Compare, in 2005. Hospital Compare, a consumer-oriented website that provides information on how well hospitals provide recommended care in such areas as heart attack, heart failure, and pneumonia, is available through the CMS website (www.cms.gov). In a further effort, the CMS, in 2008, announced that it will no longer reimburse hospitals, under Medicare guidelines, for care provided for "preventable complications" such as hospital-acquired infections. This reimbursement policy was extended to Medicaid reimbursement in 2011
What role does healing in faith communities have in public and community health?
Faith community nurses work in close relationship with individuals, families, and faith communities to coordinate programs and services that significantly affect health, healing, and wholeness. Faith community nurses balance knowledge and skill in their role to facilitate the faith community as it becomes a caring place that is a source of health and healing for all members of the community. Faith community nurses address health concerns of individuals, families, and groups of all ages. The integration of faith and health within the caring community results in beneficial outcomes. People who encounter physical and emotional illness and who are able to call upon their faith beliefs and religious traditions are able to increase coping skills and realize spiritual growth. Individuals draw on their faith traditions and previous learning experiences as well as accept support from family and friends to interpret brokenness, disasters, jobs, births, deaths, illness, and recovery.
What are the responsibilities of Federal, State and Local PH system?
Federal: The U.S. Department of Health and Human Services (USDHHS; or simply HHS) is the agency most heavily involved with the health and welfare concerns of U.S. citizens. The U.S. Public Health Service (USPHS; or simply PHS) is a major component of the Department of Health and Human Services. The PHS consists of eight agencies: - Agency for Healthcare - Research and Quality, - Agency for Toxic Substances and Diseases Registry, - Centers for Disease Control and Prevention, - Food and Drug Administration, - Health Resources and Services Administration, - Indian Health Service, - National Institutes of Health, - Substance Abuse and Mental Health Services Administration An important agency and a recent addition to the federal government, the U.S. Department of Homeland Security (USDHS, or simply DHS), was created in 2003 (USDHS, 2014). The mission of the DHS is to prevent and deter terrorist attacks and protect against and respond to threats and hazards to the nation. State: In addition to standing ready for disaster prevention or response, state health departments have other equally important functions, such as health care financing and administration for programs such as Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State systems also have an important role in direct assistance to local health departments, including ongoing assessment of health needs. Local HS Health System: The local health department has direct responsibility to the citizens in its community or jurisdiction. Services and programs offered by local health departments vary depending on the state and local health codes that must be followed, the needs of the community, and available funding and other resources. Local health departments vary in providing sick care or even primary care. More often than at other levels of government, public health nurses at the local level provide population level or direct services. Some of these nurses deliver special or selected services, such as follow-up of contacts in cases of tuberculosis or venereal disease or providing child immunization clinics. Others provide more general care, delivering services to families in certain geographic areas. This method of delivery of nursing services involves broader needs and a wider variety of nursing interventions. The local level often provides an opportunity for nurses to take on significant leadership roles, with many nurses serving as directors or managers.
What are the most appropriate methods of assessment, intervention, and evaluation for community and public health?
Five methods of collecting data useful to the nurse are analysis of existing secondary data, and primary data collection through informant interviews, participant observation, surveys, and windshield surveys. • Nurses should identify and partner with gatekeepers, formal, or informal community leaders, to gain entry or acceptance into the community. • The planning phase includes analyzing and establishing priorities among community health problems already identified, establishing goals and objectives, and identifying intervention activities that will accomplish the objectives. • Once high-priority problems are identified, broad relevant goals and objectives are developed; the goal is generally a broad statement of the desired outcome while the objectives are precise statements of the desired outcome. • Intervention activities, the means by which objectives are met, are the strategies that clarify what must be done to achieve the objectives, the ways change will be effected, and the way the problem will be interpreted. • Implementation, the next phase of the nursing process, means transforming a plan for improved community health into achieving goals and objectives. This essentially is the implementation of the program. • Simply defined, evaluation is the appraisal of the effects of some organized activity or program.
Who are the historical figures and leaders who had a profound impact on addressing aggregate and population health?
Florence Nightingale: The most important contribution made to community-oriented nursing. Expansion of the role of nursing to include health-promotion practices. Considered to be the founder of Nursing. Led a mission to the Crimean War and developed nursing procedures and care in the British hospitals in scutari . Wrote the first texts on nursing and founded a movement of Nightingale training schools for nurses. Frances Root: First trained nurse in the US; she was hired in 1887 by the Women's Board of the New York City Mission to provide care to sick persons at home. Lina Rogers: a Henry Street Settlement resident who became the first school nurse. Mary Breckinridge: woman who established the Frontier Nursing Service (FNS) in 1925 to emulate systems of care used in the Highlands and islands of Scotland. Introduced the first nurse-midwives into the United States. Frontier Nursing Service: Rural nursing service founded by Mary Breckinridge in Kentucky as the Kentucky Committee for Mothers and Babies Influenced the development of nurse midwifery in the US Lillian Wald: first public health nurse in US and a social reformer whose influence established the context for community, public health nursing, school nursing, insurance payment for nursing, national organization for public health nurses and US Children's Bureau; founded the Henry Street Settlement in NY in 1893, which later became the Visiting Nurse Service of NYC in 1893. Metropolitan Life Insurance Company: with assistance from Lillian Wald, instituted the first community health program for employees in 1909. It also began a cooperative program with visiting nurse associations to provide care for sick policy holders. William Rathbone: British philanthropist who founded the first district nursing association in England. National League for Nursing: a national organization for nurses that is composed of nurses and consumers and was created in 1952 with the closure of the National Organization for Public Health Nursing and other professional nursing organizations. National Organization for Public Health Nursing (NOPHN): an early organization for public health nurses, founded in 1912. It was dissolved in 1952, and many of its functions were distributed primarily to the National League for Nursing. NOPHN major accomplishments: University education in population based care; health insurance reimbursement for nursing (i.e. post discharge nursing care at home); Established PH nursing for military outposts in WWI. Responded to 1918 worldwide influenza pandemic in US.
What is the future of genomics in Public Health?
Genetics and genomics will change future practice in several areas including: - how students are educated - how nurses collect and use health histories - how nurses learn and apply innovative biotechnology - how prevention and health education is provided - administration of innovative and evolving therapies - the role epigenetics has in current research of disease - in ongoing public health debates including the moral, ethical, legal, and social issues around this powerful new field of knowledge.
What is the purpose of Healthy People and what are its national health objectives?
Healthy People 2020: a set of principles comprised of a large number of objectives related to 38 topic areas. These objectives are designed to serve as a road map for improving the health of all people in the United States during the second decade of the twenty-first century. Healthy people 2020 overarching goals: Achieve health equity, eliminate disparities, improve the health of all groups; Eliminate preventable disease, disability, injury, premature death; Promote healthy development and behaviors; Create environments that promote good health for all
What historical events have influenced a holistic approach to population health?
Sheppard-Towner Act: Maternity & Infancy Act of 1921, provided federal matching funds to establish maternal & child health divisions in state health depts. Ended in 1929 d/t concerns it gave too much power to the federal government & too closely resembled socialized medicine. Social Security Act of 1935: federal legislation that attempted to overcome national setbacks of the Depression. Title VI provided funding for health protection & promotion through education and employment of public health nurses & to establish & maintain adequate health services. Town and Country Nursing Service: the later name of the American Red Cross's Rural Nursing Service. Shattuck Report: Called for innovations- Establishment of PH infrastructure Environmental sanitation; food, drug & disease control; well child care; health education; tobacco & alcohol control; urban planning & preventive education in medical training American Recovery and Reinvestment Act of 2009: economic stimulus designed to offset some of the losses related to the recession that provided 2 billion in additional funding for community health centers, including money for increased demand for services likely to occur in a time of rising unemployment Implementation of Medicare and Medicaid programs in 1966 established new possibilities for supporting community health nursing care but encouraged agencies to focus on services provided after acute care rather than prevention. Healthy People 2000, Healthy People 2010, and recent disasters and acts of terrorism have brought renewed emphasis on prevention to nursing.
How has the status of nursing in community health practice changed in the twenty-first century?
The Healthy People program, recent disasters and acts of terrorism, and most recently the Patient Protection and Affordable Care Act of 2010 have brought renewed emphasis on prevention to public and community health nursing. During the late twentieth and early twenty-first century, challenges have continued to trigger growth and change in nursing in the community. Nurses continue to care for the vulnerable populations, provide illness care, and prevent acute illness while delivering care that is safe and high in quality.
What is the role of nursing in occupational health and in the American workforce?
The customary role of the occupational health nurse has extended beyond emergency treatment and prevention of illness and injury to include the promotion and maintenance of health, overall risk management, care for the environment, and efforts to reduce health-related costs in business. The inter-professional nature of occupational health nursing has become more critical as occupational health and safety problems require more complex solutions. The occupational health nurse frequently collaborates closely with multiple disciplines and industry management, as well as with representatives of labor. Constitutes the largest group of occupational health professionals and hold positions as nurse practitioners, clinical nurse specialist, managers, supervisors, consultants, educators, and researchers. Many occupational health nurses also work as independent contractors or have their own business that provide occupational health and safety services to industry, as well as consultation.
How do legislative and regulatory policies influence the effect of the environment on health and disease patterns?
The government manages environmental exposures through the promulgation and enforcement of standards and regulations that may limit a polluter's ability to put hazardous chemicals into food, water, air, or soil.
What is community-based nursing practice? How is this different from community-oriented nursing practice?
• Community-based nursing practice: Focus on individuals and families where they live, work, and go to school; care is setting specific in the emphasis is on acute and chronic care. Setting specific practice in which care is provided for "sick" individuals and families where they live, work, and go to school. This emphasis of practice is acute and chronic care and the provision of comprehensive coordinated, and continuous services Community-based public health nurses may be clinically oriented to the individual client, and who combine some population-focused strategies and direct care clinical strategies in programs serving specified populations • Community health nursing practice: Focus on health of individuals, families, and groups in the effect on the health of the community as a whole. Nurses with specialized education and training in the area of Public Health/community health nursing who use nursing and Public Health principles to promote and sustain the health of populations in neighborhood and community settings
What are the core functions of public health and the services generally provided by practitioners of public health?
• Public Health Core Functions: assessment, policy development, and assurance • Assessment Core Function: systematically collecting data on the population, monitoring the population's health status, and making information available about the health of the community. Assessment essential public health services: Monitor health status to identify community health problems; Diagnose and investigate health problems and health hazards in the community. • Policy Development Core Function: the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy. Policy Development essential public health services: Inform, educate, and empower about health issues; Mobilize community partnerships to identify and solve health problems; and develop policies and plans that support individual and community health efforts. • Assurance Core Function: the role of public health in ensuring that essential community-oriented health services are available. Assurance essential public health services: Enforce laws and regulation r/t health and safety; Link people to needed health services and assure provision of care when unavailable; Assure a competent health care workforce; Evaluate effectiveness, accessibility, and quality of health services. • Essential public health services that serve all functions: Research for new insights and innovative solutions to health problems.
What is the role of the public health nurse specialist? How does this role influence nursing practice in the community?
• Public health nursing specialists: Practice is community-ORIENTED and uses population focused strategies for carrying out the core public health functions. • Roles may include director of nursing for a health department, director of the health department, state commissioner for health, director of maternal and child health services for a state or local health department, director of wellness for a business or educational organization, and director of preventive services for an integrated health system. Nurses can occupy all of these roles, but, with the exception of director of nursing for a health department, they are in the minority. Unfortunately, nurses who occupy these roles are often seen as "administrators" and not as public health nursing specialists. However, those who work in such roles have the opportunity to make decisions that affect the health of population groups and the type and quality of health services provided for various populations. • Public health nursing: The practice of promoting and protecting the health of populations using knowledge from nursing, Social, and Public health sciences. Synthesis of nursing theory and Public Health theory applied to promoting and preserving the health of populations. The focus of practice is the community as a whole.
