Chapter7

Copyright © 2008 Thomson Delmar Learning

1

Chapter 7 Chapter 7

Population-Based Health Care Practice


2

ObjectivesObjectives

Upon completion of this chapter, the reader should be able to: Discuss the social mandate to provide population-based health care at the global, national, state, and local levels

Describe how population-based nursing is practiced within the community and the health care system


3

ObjectivesObjectives

Identify vulnerable and high-risk population groups for whom specific health promotion and disease prevention services are indicated

Outline a multidisciplinary population-based planning and evaluation process that includes partnerships with the community and health care consumers


4

Population-Based Population-Based Health Care PracticeHealth Care Practice

The development, provision, and evaluation of multidisciplinary health care services to population groups experiencing increased health care risks or disparities

It involves partnership with health care consumers and the community in order to improve the health of the community and its population groups


5


Vulnerable population groups Subgroups of a community that are powerless, marginalized, and disenfranchised and are experiencing health disparities


6


Health risk factors are variables that increase or decrease the probability of illness or death

Health determinants are variables that may cause changes in the health status of individuals or groups and include: Biological factors Psychosocial factors Environmental factors (physical and social) Health systems factors or etiologies


7

Goals of Population-Goals of Population-Based Health CareBased Health Care

Improvement of access to health care services

Improvement of quality of health care services

Reduction of health disparities among different population groups

Reduction of health care delivery costs


8

Outcomes MeasurementOutcomes Measurement

Population health status Quality of life Functional health status


9

Health StatusHealth Status

Health status The level of health of an individual, family, group, population, or community

Quality of life The level of satisfaction one has with the actual conditions of one’s life

Health-related quality of life Refers to one’s level of satisfaction with those aspects of life that are influenced by one’s health status and health risk factors


10

Functional Health Functional Health StatusStatus

Functional health status The ability to care for oneself and meet one’s human needs

Activities of daily life Activities related to toileting, bathing, grooming, dressing, feeding, mobility, and verbal and written personal communication

Instrumental activities of daily living Related to home management, financial management, seeking health care, and meeting spiritual needs


11

Health Determinant Health Determinant ModelsModels

Provide conceptual tools to use in assessing and addressing the priority health needs of at-risk population groups

Healthy People 2010 emphasizes four key elements to achieve health improvement Goals Objectives Determinants of health Health status


12

Health DisparitiesHealth Disparities

Differences in health risks and health status measures that reflect the poorer health status that is found disproportionately in certain population groups

Leads to unequal burdens in disease morbidity and mortality rates borne by racial and ethnic groups in comparison to the dominant racial or ethnic group in society


13

Health Care Systems Health Care Systems DisparitiesDisparities

Differences in health care system access and quality of care for different racial, ethnic, and socioeconomic population groups that persist across settings, clinical areas, age, gender, geography, and health needs and disabilities

Result in poorer health care outcomes


14

Major Health Major Health IndicatorsIndicators

Physical activity

Overweight/obesity

Tobacco use Substance abuse Responsible sexual behavior

Mental health Injury and violence

Environmental quality

Immunizations and access to health care


15

Culturally Inclusive Culturally Inclusive Health CareHealth Care

U.S. population is becoming more diverse Ethnic minorities in the United States who have been marginalized from mainstream society experience more health care disparities and increased rates of morbidity, mortality, and burden of disease

The proportion of ethnic minorities in the registered nurse workforce in 2004 continues to lag behind the proportion of ethnic minorities in the U.S. population


16

Barriers in the Barriers in the WorkplaceWorkplace

Lack of awareness of differences

Lack of time Ethnocentrism Bias and prejudice Lack of skills to address differences

Lack of organizational support


17

Culturally Inclusive Culturally Inclusive Health Care SystemHealth Care System

One in which health care is population based

Requires significant change in the current health care system

Will require increased diversity in the health care workforce


18

Population-Focused Population-Focused Nursing PracticeNursing Practice

Nursing activities that focus on all of the people and reflect responsibility to and for the people

Focus is on: Maximizing health status Maximizing functional abilities Improving the quality of life of groups of health care consumers


19

Population-Based Population-Based Nursing PracticeNursing Practice

The practice of nursing in which the focus of care is to improve the health status of vulnerable or at-risk population groups within the community by employing health promotion and disease prevention interventions across the health continuum

Holistic in nature Seeks to empower population groups by enhancing their protective factors and resiliency


20

Protective FactorsProtective Factors

Client strengths and resources are used to combat health threats that compromise core human functions

Resilience The social and psychosocial capacity of individuals and groups to adapt, succeed, and persevere over time in face of recurring threats to psychosocial and physiologic integrity


21

Population-Based Population-Based Nursing Practice ModelNursing Practice Model Population-based interventions encompass three levels: Community Systems within the community Individuals, families, and groups


22

Population-Based Population-Based Nursing Practice Nursing Practice InterventionsInterventions

Initiate a community health assessment

Provide nursing interventions in a culturally sensitive and appropriate manner

Apply the nursing process in working with communities, organizations, and population groups


23

Nontraditional Model of Nontraditional Model of Population-Based Nursing Population-Based Nursing

PracticePractice Vulnerable or at-risk populations are identified before community assessment

Subsequent community assessment focuses on health determinants related to the at-risk groups

Traditional model assesses overall community needs first, and at-risk population needs second


24

Nursing Process Applied Nursing Process Applied to Population-Based to Population-Based Nursing PracticeNursing Practice

Assessment Diagnosis Planning and implementation Evaluation


25

AssessmentAssessment

Community level Physical environment Social environment Policies and interventions

Health systems level Access to quality health care Behavioral Data analysis


26

DiagnosisDiagnosis

Identify North American Nursing Diagnosis Association (NANDA) category

Identify etiology and list key evidence supporting diagnostic category


27

Planning and Planning and ImplementationImplementation

Select and employ population-based nursing intervention model

Examples of population-based nursing intervention models: Minnesota model Virginia model


28

EvaluationEvaluation

Program evaluation is integral part of evaluation process

Justification of resources and budget is necessary

Cost benefit analysis is appropriate Evaluate access, quality, cost, and equity Collect data and develop statistics Share results with multidisciplinary teams, health consumers, and community partnerships

Identify unmet needs and further interventions

Health & Medicine

Chapter7