Public Health Care Nursing Discussion

Chapter 1: Public Health Nursing: Present, Past, and Future Chapter Highlights ❖ Healthcare changes in the 21st century ❖ Characteristics of public health nursing ❖ Public health nursing roots ❖ Challenges for practice in the 21st century Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? Healthcare disparities are social conditions in which people live and work. Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #1 False Rationale: Social determinants of health are social conditions in which people live and work. Healthcare disparities are gaps in healthcare experienced by one population compared with another. Copyright © 2020 Wolters Kluwer · All Rights Reserved Major Changes in Healthcare in the 21st Century ❖ Development of patient/client-centered care ❖ Increased use of technology ❖ Increased personal responsibility Copyright © 2020 Wolters Kluwer · All Rights Reserved Healthcare Changes in the 21st Century #1 ❖ Social determinants of health are social conditions in which people live, their income, their social status, their education, their literacy level, their home and work environment, their support networks, their gender, their culture, and the availability of health services Copyright © 2020 Wolters Kluwer · All Rights Reserved Healthcare Changes in the 21st Century #2 ❖ Healthcare disparities—differences in healthcare and health outcomes experienced by one population compared with another Copyright © 2020 Wolters Kluwer · All Rights Reserved Role of Government in Healthcare ❖ Three core functions are as follows: o Assesses healthcare problems o Intervenes by developing relevant healthcare policy that provides access to services o Ensures that services are delivered and outcomes are achieved Copyright © 2020 Wolters Kluwer · All Rights Reserved Patient Protection and Affordable Care Act (PPACA) ❖ Provide affordable health insurance coverage to most Americans ❖ Lower costs ❖ Improve access to primary care ❖ Preventive care and prescription benefits ❖ Cover pre-existing conditions ❖ Extend young adults’ coverage Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #2 ❖ What is one of the core functions of the role of government in healthcare? A. Provide affordable health insurance coverage B. Improve access to primary care C. Lower costs D. Assess healthcare problems Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #2 D. Assess healthcare problems Rationale: Three core functions are to assess healthcare problems, intervene by developing relevant healthcare policy that provides access to services, and ensure that services are delivered and outcomes are achieved. One of the goals of the Patient Protection and Affordable Care Act (PPACA) is to provide affordable health insurance coverage. Copyright © 2020 Wolters Kluwer · All Rights Reserved Patient/Client-Centered Care ❖ Cultural traditions ❖ Personal preferences ❖ Values ❖ Families ❖ Public Health Care Nursing Discussion

Lifestyles Copyright © 2020 Wolters Kluwer · All Rights Reserved Technology ❖ Rapidly advancing forms of technology are dramatically improving lives. Copyright © 2020 Wolters Kluwer · All Rights Reserved Health Information Technology ❖ Health information technology (HIT)—comprehensive management of health information and its exchange between consumers, providers, government, and insurers in a secure manner ❖ Electronic health records Copyright © 2020 Wolters Kluwer · All Rights Reserved Telehealth ❖ Use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration Copyright © 2020 Wolters Kluwer · All Rights Reserved Personal Responsibility for Health ❖ Active participation in one’s own health through education and lifestyle changes Copyright © 2020 Wolters Kluwer · All Rights Reserved Public Health Nursing ❖ Public health nursing—population-based practice, defined as a synthesis of nursing and public health within the context of preventing disease and disability and promoting and protecting the health of the entire community Copyright © 2020 Wolters Kluwer · All Rights Reserved Principles of Public Health Nursing #1 ❖ Client or unit of care is the population. ❖ Primary obligation is to achieve the greatest good for the greatest number of people or people as a whole. ❖ Public health nurses collaborate with the client as an equal partner. Copyright © 2020 Wolters Kluwer · All Rights Reserved Principles of Public Health Nursing #2 ❖ Primary prevention is the priority in selecting appropriate activities. ❖ Public health nursing focuses on strategies that create healthy environmental, social, and economic conditions in which populations may thrive. Copyright © 2020 Wolters Kluwer · All Rights Reserved Principles of Public Health Nursing #3 ❖ A public health nurse is obligated to actively identify and reach out to all who might benefit from a specific activity or service. ❖ Optimal use of available resources and creation of new evidence-based strategies is necessary to assure the best overall improvement in the health of populations. Copyright © 2020 Wolters Kluwer · All Rights Reserved Principles of Public Health Nursing #4 ❖ Collaboration with other professions, populations, organizations, and stakeholder groups is the most effective way to promote and protect the health of people. Copyright © 2020 Wolters Kluwer · All Rights Reserved Scope and Standards of Practice ❖ Public Health Care Nursing Discussion

The American Nurses Association sets the scope and standards for all professional nursing practice. ❖ The publication Public Health Nursing: Scope and Standards of Practice establishes the characteristics of competent public health nursing practice and is the legal standard of practice. Copyright © 2020 Wolters Kluwer · All Rights Reserved Competencies for Public Health Nursing Practice ❖ Three tiers of practice ❖ Competencies associated with that level of practice Copyright © 2020 Wolters Kluwer · All Rights Reserved Public Health Intervention Wheel ❖ 17 interventions ❖ Actions taken on behalf of individuals, families, communities, and systems to protect or improve health status Copyright © 2020 Wolters Kluwer · All Rights Reserved Public Health Nursing Interventions ❖ Population-based model ❖ Applied to individuals, families, communities, or within systems ❖ Focuses upon prevention Copyright © 2020 Wolters Kluwer · All Rights Reserved Education for Public Health Nursing Practice ❖ Public health nursing practice o Baccalaureate degree in nursing (BS or BSN) o Generalist master’s degree as clinical nurse leader (CNL) ❖ Public health nursing specialists in population health o MSN o MPH o MSN/MPH o Doctoral degrees: PhD, DNP, DrPH Copyright © 2020 Wolters Kluwer · All Rights Reserved Roots of Public Health Nursing ❖ Early civilization ❖ Middle Ages ❖ English Poor Law ❖ Public Health Care Nursing Discussion

Variety of reforms in 1800s ❖ Victorian times ❖ District nursing Copyright © 2020 Wolters Kluwer · All Rights Reserved Public Health Initiatives in Early America ❖ American social values strongly influenced by British traditions ❖ Need for organized public health system ❖ Lemuel Shattuck ❖ Dorothea Dix ❖ Clara Barton ❖ Lillian Wald Copyright © 2020 Wolters Kluwer · All Rights Reserved Public Health Initiatives in the 20th Century ❖ Mary Breckinridge ❖ Early 20th-century federal healthcare initiatives ❖ Public health in the second half of the century Copyright © 2020 Wolters Kluwer · All Rights Reserved The First Decade of the 21st Century ❖ Department of Homeland Security: fosters an allhazards, all-disciplines approach to emergency management ❖ Must be flexible, be politically active, embrace change, and refresh their knowledge of public health issues on a continual basis Copyright © 2020 Wolters Kluwer · All Rights Reserved Engaging in Evidence-Based Practice ❖ Evidence-based nursing is the integration of the best evidence available with clinical expertise and the values of the client to increase the quality of care. Copyright © 2020 Wolters Kluwer · All Rights Reserved Evidence-Based Public Health ❖ Public health endeavor with judicious use of evidence derived from a broad variety of science and social science research Copyright © 2020 Wolters Kluwer · All Rights Reserved Epidemiology ❖ Science of prevention ❖ Knowledge of the natural history of diseases and the identified (risk) factors that increase a person’s susceptibility to illness Copyright © 2020 Wolters Kluwer · All Rights Reserved Challenges for Public Health Nursing in the 21st Century #1 ❖ Engaging in evidence-based practice ❖ Helping eliminate health disparities in underserved populations ❖ Demonstrating cultural competence ❖ Planning for community change ❖ Contributing to a safe and healthy environment Copyright © 2020 Wolters Kluwer · All Rights Reserved Challenges for Public Health Nursing in the 21st Century #2 ❖ Responding to emergencies, disasters, and terrorism ❖ Responding to the global environment Copyright © 2020 Wolters Kluwer · All Rights Reserved Chapter 3: Health Policy, Politics, and Reform Chapter Highlights #1 ❖ Healthcare policy and the political process ❖ Healthcare finance and cost–benefit in relation to health policy ❖ Access to healthcare and insurance facts in the United States ❖ Healthcare workforce diversity and its effects on the quality of healthcare ❖ Nursing’s role in shaping healthcare policy Copyright © 2020 Wolters Kluwer · All Rights Reserved Chapter Highlights #2 ❖ Quality of care and evaluation ❖ Information management facts ❖ Equity in healthcare access ❖ Ethical consideration in health policy ❖ Political advocacy, how to be politically active and advocate Copyright © 2020 Wolters Kluwer · All Rights Reserved Chapter Highlights #3 ❖ Health advocacy and healthcare reform ❖ Affordable Care Act (ACA) overview and updates ❖ Community-based services and healthcare reform ❖ Health services research application to healthcare policy Copyright © 2020 Wolters Kluwer · All Rights Reserved Healthcare Policy and Political Process ❖ Policies: set of principles that govern an action to achieve a given outcome, or guidelines that direct individuals’ behavior toward a specific goal ❖ Public health policy: decisions made in regard to the health of the individual and the community ❖ Health policies: impact on the health of an individual, a family, and a population or community Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? Health policies impact on the health of an individual, a family, and a population or community. Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #1 True Rationale: Health policies impact on the health of an individual, a family, and a population or community. Copyright © 2020 Wolters Kluwer · All Rights Reserved Involving Politics ❖ Process of influencing the allocation of resources needed to enable policy and involves the strategies needed to achieve the desired goals. ❖ Policy-making takes a great deal of effort, time, and commitment. o Setting an agenda o Policy formulation o Policy adoption o Policy implementation o Policy assessment o Policy modification Copyright © 2020 Wolters Kluwer · All Rights Reserved Healthcare Finances and Cost-Benefit ❖Public Health Care Nursing Discussion

Economics is the study of how individuals, groups, organizations, and society allocate and utilize resources. ❖ When a policy is evaluated for its effectiveness, there is an interest in keeping the cost of a specific health program within reason, and it is critical to consider the overall costs and benefits of an existing program when a more efficient and effective service is identified and adopted. Copyright © 2020 Wolters Kluwer · All Rights Reserved Access to Care and Health Insurance ❖ The U.S. healthcare system is a unique system of both independent and collaborative power and action by both federal and state governments. Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? The U.S. healthcare system is a unique system of both independent power and action by the federal government. Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #2 False Rationale: The U.S. healthcare system is a unique system of both independent and collaborative power and action by both federal and state governments. Copyright © 2020 Wolters Kluwer · All Rights Reserved Nursing’s Role in Shaping Healthcare Policy ❖ Nursing has a rich history as a unique profession, with its own values, ethics, respect, integrity, and responsibility. Nurses’ contributions to the policies are unlimited; there is a need for greater coordination of action to ensure that nursing is actively supported and involved in influencing and shaping health and healthcare policies. Copyright © 2020 Wolters Kluwer · All Rights Reserved Historical Highlights on Nursing Political Involvement ❖ Mid-‘70s and early ‘80s: Political involvement of nurses ❖ 1976: Important year of advocacy ❖ 1990s: Nurses included in healthcare policy formation Copyright © 2020 Wolters Kluwer · All Rights Reserved What Does It Mean to Be Politically Active? ❖ Personal and professional political involvement of nurses ❖ Nurses must be knowledgeable about issues, laws, and policy ❖ Why is nurse-informed political involvement? o Direct caregivers o Awareness of patient safety and satisfaction, access to services, clinical outcomes, and health disparities o Positioned to see impact of policy on individuals Copyright © 2020 Wolters Kluwer · All Rights Reserved Nursing Advocacy and Policy Participation ❖ Patient advocacy ❖ Political advocacy Copyright © 2020 Wolters Kluwer · All Rights Reserved How to Be Politically Involved? ❖ Evidence-based practice examples ❖ Nurses’ milestones in policy development have contributed to: o Quality outcomes o Decreases in cost o Expanded access o Major differences to the health of the nation Copyright © 2020 Wolters Kluwer · All Rights Reserved Advocacy Activities of Professional Nursing Organizations ❖ Role of professional nursing organizations o ANA o NLN o ICN Copyright © 2020 Wolters Kluwer · All Rights Reserved Current Situation of Nursing Involvement: Challenges and Barriers ❖ Not enough time to get involved ❖ Heavy workloads with understaffing ❖ Perception of powerlessness ❖ Gender issues ❖ Political action breaching family time ❖ Anxiety with public speaking ❖ Lack of knowledge in legislative process ❖ Fear of retaliation Copyright © 2020 Wolters Kluwer · All Rights Reserved Quality of Care ❖ Safety ❖ Effectiveness ❖ Patient centeredness ❖ Timeliness ❖ Equality ❖ Quality of care is defined by the Institute of Medicine (2001) as the degree to which health services for individuals and populations increase the likelihood of desired outcomes, and are consistent with current knowledge. ❖ It is extremely difficult to evaluate the complexities of the quality of care for the U.S. population. Copyright © 2020 Wolters Kluwer · All Rights Reserved Information Management ❖ U.S. policy-makers have made the adoption of health information technology a priority so that health records can be kept electronically, assisting patients, providers, and insurers. Copyright © 2020 Wolters Kluwer · All Rights Reserved Equity and Equality in Healthcare Access and Quality ❖ Because of the vast disparities in healthcare access and quality, President Obama has made healthcare his top priority, promising affordable and adequate healthcare insurance for all Americans. Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #3 Is the following statement true or false? Equality is healthcare that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status. Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #3 True Rationale: Equality is healthcare that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status. Copyright © 2020 Wolters Kluwer · All Rights Reserved Community-Based Services Association with Healthcare Reform ❖ Federally qualified health centers ❖ Patient-centered medical home ❖ Accountable care organizations ❖ Meaningful use Copyright © 2020 Wolters Kluwer · All Rights Reserved Ethical Considerations ❖ ANA Code of Ethics with Interpretive Statements ❖ Code of Ethics for Nurses ❖ Social Policy Statement ❖ Scope and Standards of Practice in Nursing Copyright © 2020 Wolters Kluwer · All Rights Reserved Health Advocacy and Healthcare Reform ❖ Advocacy is collaborating with colleagues and engaging in conversations with decision-makers ❖ Healthcare systems are dynamic Copyright © 2020 Wolters Kluwer · All Rights Reserved Overview of the ACA Prior to the End of Obama Presidency ❖ Patient Protection and Affordable Care Act ❖ Health Care and Education Reconciliation Act Copyright © 2020 Wolters Kluwer · All Rights Reserved Health Services Research ❖ Research continues to be an influencing power by documenting the need for accelerated reform in order to achieve quality care, proper information management, insurance for all, and equity of access. Copyright © 2020 Wolters Kluwer · All Rights Reserved …