1. Explain the role of the community health nurse in partnership with community stakeholders for population health promotion. Explain why it is important to appraise community resources (nonprofit, spiritual/religious, etc.) as part of a community assessment and why these resources are important in population health promotion.
Explore the American Public Health Association (APHA) website.
2. Discuss how geopolitical and phenomenological place influence the context of a population or community assessment and intervention. Describe how the nursing process is utilized to assist in identifying health issues (local or global in nature) and in creating an appropriate intervention, including screenings and referrals, for the community or population.
Explore the Jackson County Health Department (JCHCC) website. In addition, explore the relevant public health site for your own county or state.
View the “All the Gear in the CDC’s Disease Detectives Use in the Field” video, by WIRED (2018), located on the YouTube website.
Explore the Maricopa County Public Health website. In addition, explore the relevant public health site for your own county or state.
Explore the California Department of Public Health website. In addition, explore the relevant public health site for your own county or state.
“We often think of nursing as giving meds on time, checking an X-ray to see if the doctor needs to be called, or taking an admission at 2:00 a.m. with a smile on our faces. Too often, we forget all the other things that make our job what it truly is: caring and having a desire to make a difference.”—Erin Pettengill (National CPR Association, n.d.)
How does expanding knowledge of population, community, and public health nursing improve the nurse’s practice?
What are expected competencies for the nurse practicing within population groups?
How does the nurse apply the nursing process and collaborate with others to conduct a population’s health assessment?
Which community resources are useful during planning and interventions for a population’s health?
Nursing care of populations involves working with larger groups of people and their corresponding multiple health care needs. Community and public health nurses consider the effect of ethnicity, culture, spiritual values, and geographic and socioeconomic conditions on the wellness of the population. Diverse populations have various health disparities and health inequities that affect their ability to maintain health and meet health care needs.
A greater understanding of historical and theoretical concepts provides a foundation for the nurse’s approach to care of populations. The role of the public health nurse and the essential function of public health services are explored in this chapter. The nursing process is applied as an approach to assess a community or specific population. Impediments to effective practice are discussed to aid the nurse’s awareness of barriers to overcome.
Nursing & Conceptual Frameworks
Population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” (Kindig & Stoddart, 2003, p. 381). Population health has a goal of measuring, intervening, and improving health disparities among groups, as well as the distribution of health, all of which is driven by assessment and statistical data. Public health, a subcomponent of population health, is the practice of protecting and promoting quality of life and holistic health of persons and communities through the use of science, research, and direct care.
The American Public Health Association (APHA) defines public health nursing as “the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences” (American Public Health Association [APHA], 2013, p. 2). Interdisciplinary public health practices aim to prevent disease outbreaks, injuries, and poor health while promoting cost-effective measures that improve quality of life and health as well as reduce environmental hazards (APHA, n.d.; Centers for Disease Control and Prevention Foundation, 2017).
Development of the Public Health Nursing Role
The historical path leading to the discipline of public/community health nursing began more than a century ago. Several nursing pioneers fashioned programs that led to the development of organized public health delivery.
Florence Nightingale initiated “health visitors” in 1892, a group composed of lay female missionaries with specialized training for instruction of health (Buhler-Wilkinson, 1985). Much of the focus was teaching women about caring for themselves and their children. This was the foundation of England’s district nursing today.
Lillian Wald established the term public health nurse with a focus on treating social and economic problems along with illness. In 1893, Wald and Mary Brewster put this belief into practice on the Lower East Side tenements of New York. Two years later, this led to the establishment of the Henry Street Settlement and, later, the development of the Visiting Nurses Association (VNA) (Fee & Bu, 2010).
Mary Breckinridge introduced nurse midwifery to the United States in 1925. She traveled on horseback to deliver modern health care to the most inaccessible and poorest areas of Appalachia in Kentucky (Frontier Nursing Service, 2015). This lead to the subsequent development of the Frontier Nursing Service (FNS) and the expansion of public health nursing into remote rural areas (Frontier Nursing University, n.d.).
The public health profession continues to evolve. Various policy reforms in the United States have shaped public health nursing to become what it is today. Public health needs drive development of programs to improve public health. Sanitation reforms occurred as public health nursing emerged. Public health education, improved waste disposal methods, and clean-water policies reinforced the importance of the environment to the nation’s health.
In 2004, a presidential order, signed by President George W. Bush, established the Office of National Coordinator for Health Information Technology, which included incentives for providers using health information technology (HIT), motivating them to utilize electronic medical records (Bush, 2004; DeSalvo, Dinkler, & Stevens, 2015).
Timely and efficient access to patient-related information ushered in a new era of health informatics and population health. The 2010 Affordable Care Act (ACA) reinforced the importance of the use of HIT. Gradual transition of services to outpatient or community settings further reinforce the nurse’s role in population health management and health information technology.
Born from the rise of nursing specialty interest groups, the National Organization of Public Health Nursing (NOPHN) emerged with Lillian Wald as the first president. Many groups have since formed to address the varying needs of nurses across settings and clinical specialties, including the American Nurses Association (ANA).
The ANA, the largest nursing organization, represents nurses across the United States, reinforcing the role of public health nursing. The ANA recognizes and promotes the Quad Council Coalition of Public Health Nursing Organizations (QCC or Quad Council) and public health nursing’s scope and standards of practice. Also, The ANA also supports nursing involvement in public health advocacy, education, and policy, along with evolving health issues (American Nurses Association [ANA], n.d.).