Harkness2e chap01 ppt

Copyright © 2016 Wolters Kluwer • All Rights Reserved

Chapter 1: Public Health Nursing: Present, Past,

and Future

2Copyright © 2016 Wolters Kluwer • All Rights Reserved

Chapter Highlights• Healthcare changes in the 21st

century• Characteristics of public health

nursing• Public health nursing roots• Challenges for practice in the 21st

century


QuestionIs the following statement true or false?Healthcare disparities are social conditions in which people live and work.


AnswerFalseRationale: 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.


Major Changes in Healthcare in the 21st Century

• Development patient/client-centered care

• Increased use of technology• Increased personal responsibility


Healthcare Changes in the 21st Century

• Social determinants of 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


Healthcare Changes in the 21st Century (cont.)

Healthcare disparities—gaps in healthcare experienced by one population compared with another


Role of Government in HealthcareThree core functions are as follows:• Assesses healthcare problems• Intervenes by developing relevant healthcare policy

that provides access to services• Ensures that services are delivered and outcomes are

achieved


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• Coverage of pre-existing conditions• Young adults’ coverage


QuestionWhat is one of the core functions of the role of government in healthcare?A. Provide affordable health insurance coverageB. Improve access to primary careC. Lower costsD. Assess healthcare problems


AnswerD. Assess healthcare problemsRationale: Three core functions are to assess healthcare problems, intervene by developing relevant healthcare policy that provides access to services, and ensures 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.


Patient/Client-Centered Care• Cultural traditions• Personal preferences• Values• Families• Lifestyles


Technology• Rapidly advancing forms of technology

are dramatically improving lives.


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


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


Personal Responsibility for Health• Active participation in one’s own

health through education and lifestyle changes


Public Health NursingPublic 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


Principles of Public Health Nursing• 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.


Principles of Public Health Nursing (cont.)

• 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.


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.



Collaboration with other professions, populations, organizations, and stakeholder groups is the most effective way to promote and protect the health of people.



Scope and Standards of Practice• 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.


Competencies for Public Health Nursing Practice

• Three tiers of practice• Competencies associated with that

level of practice


Public Health Intervention Wheel• 17 interventions• Actions taken on behalf of individuals,

families, communities, and systems to protect or improve health status.


Public Health Nursing Interventions• Population-based model• Applied to individuals, families,

communities, or within systems• Focuses upon prevention


Education for Public Health Nursing Practice

• Baccalaureate degree in nursing• BS or BSN• Generalist master’s degree


Certification for Public Health Nursing Specialty Practice

• Eligibility criteria• Application• Steps to maintain certification• Renewal process


Roots of Public Health Nursing• Early civilization• Middle Ages• English Poor Law• Variety of reforms in 1800s• Victorian times• District nursing


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


Public Health Initiatives in the 20th Century

• Mary Breckinridge• Early 20th-century federal healthcare

initiatives• Public health in the second half of the

century


The First Decade of the 21st Century

• Department of Homeland Security: fosters an all-hazards, 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


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.


Evidence-Based Public Health• Public health endeavor with judicious

use of evidence derived from a broad variety of science and social science research


Epidemiology• Science of prevention• Knowledge of the natural history of

diseases and the identified (risk) factors that increase a person’s susceptibility to illness


Challenges for Public Health Nursing in the 21st Century

• 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


Challenges for Public Health Nursing in the 21st Century (cont.)

• Responding to emergencies, disasters, and terrorism

• Responding to the global environment