THE ROLE OF THE ROLE OF NURSING IN PUBLIC NURSING IN PUBLIC

HEALTHHEALTH

Sarah Coulter Danner MSN CPNP Sarah Coulter Danner MSN CPNP CNMCNM

Chairperson, Department of Chairperson, Department of NursingNursing

Oglala Lakota CollegeOglala Lakota College

Definition of Public Health Definition of Public Health NursingNursing

• Public health nursing is the practice Public health nursing is the practice of promoting and protecting the of promoting and protecting the health of populations using health of populations using knowledge of nursing,social and knowledge of nursing,social and public health sciencespublic health sciences

Systematic ApproachSystematic Approach

• 1. Assess the health and health care 1. Assess the health and health care needs of a population in order to identify needs of a population in order to identify sub-populations, families and individuals sub-populations, families and individuals who would benefit from health who would benefit from health promotion or who are at risk of illness, promotion or who are at risk of illness, injury, disability or premature deathinjury, disability or premature death

• 2.Develop a plan with the community to 2.Develop a plan with the community to meet the identified needs taking into meet the identified needs taking into account available resourcesaccount available resources

Systematic ApproachSystematic Approach

• 3. Implement the plan at the 3. Implement the plan at the community, family or individual levelcommunity, family or individual level

• 4.Evaluate the impact of the 4.Evaluate the impact of the interventionintervention

• 5.Use the results of the evaluation to 5.Use the results of the evaluation to influence and direct current delivery of influence and direct current delivery of care, deployment of health resources care, deployment of health resources and the development of local, state and and the development of local, state and national health policy and resources to national health policy and resources to promote health and prevent disease.promote health and prevent disease.

Role of the Public Health Role of the Public Health NurseNurse

• To: Provide input to interdisciplinary To: Provide input to interdisciplinary programs that monitor, anticipate and programs that monitor, anticipate and respond to health problems in respond to health problems in population groups for all diseases or population groups for all diseases or public health threats including public health threats including bioterrorismbioterrorism

• To: Evaluate health trends and risk To: Evaluate health trends and risk factors of population groups to help factors of population groups to help determine priorities forming targeted determine priorities forming targeted interventionsinterventions

Role of the Public Health Role of the Public Health NurseNurse

• To:To:• Work with the community or specific Work with the community or specific

population groups to develop targeted population groups to develop targeted health promotion and disease prevention health promotion and disease prevention activitiesactivities

• To: Evaluate health care servicesTo: Evaluate health care services• To: Provide health education, care, To: Provide health education, care,

management and primary care to management and primary care to individuals and families who are individuals and families who are members of vulnerable populations and members of vulnerable populations and high risk groupshigh risk groups

Public health nurses Public health nurses integrate community integrate community

involvement and knowledge involvement and knowledge of the entire population of the entire population

with the personal clinical with the personal clinical understandings of health understandings of health and illness gleaned from and illness gleaned from

the experiences of the experiences of individuals and families individuals and families within the population.within the population.

The nurse working in The nurse working in public health should be a public health should be a voice for members of the voice for members of the

community to voice community to voice problems and desiresproblems and desires

The public health nurse can The public health nurse can apply her knowledge of apply her knowledge of strategies to choose the strategies to choose the

intervention(s) that meets intervention(s) that meets the needs of a particular the needs of a particular

community, family or community, family or individualindividual

The nurse is the agent who The nurse is the agent who translates and applies the translates and applies the knowledge of health and knowledge of health and

social sciences to social sciences to individuals and population individuals and population

groups through specific groups through specific interventions, programs interventions, programs

and advocacyand advocacy

He or she also articulates He or she also articulates and translates health and and translates health and

illness experiences of illness experiences of diverse, often vulnerable, diverse, often vulnerable, individuals and families to individuals and families to

the health planners and the health planners and policy makerspolicy makers

Standards of practice have Standards of practice have been established by the been established by the

American Nurses American Nurses AssociationAssociation

The Quad Council, made up The Quad Council, made up of four public health of four public health

nursing organizations, has nursing organizations, has established core established core

competenciescompetencies

These competencies reflect These competencies reflect an agreement by the Quad an agreement by the Quad

Council that the public Council that the public health nurse requires health nurse requires

preparation at the preparation at the baccalaureate level.baccalaureate level.

However, in many states However, in many states nurses doing public health nurses doing public health work are not baccalaureate work are not baccalaureate

graduates.graduates.

Even early on, the shortage Even early on, the shortage of nurses affected the of nurses affected the hiring of BSN or MSN hiring of BSN or MSN

prepared nurses. Public prepared nurses. Public health departments could health departments could not compete with hospital not compete with hospital

systems.systems.

The specialist level The specialist level competencies require competencies require

preparation at the Master’s preparation at the Master’s level in community and /or level in community and /or

public health nursing.public health nursing.

Associate degree RNs need Associate degree RNs need extensive orientation and extensive orientation and education to achieve the education to achieve the

competencies.competencies.

Having said that, with the Having said that, with the shortage of nurses shortage of nurses

continuing and getting continuing and getting worse over the next decade worse over the next decade

what can we do as nurse what can we do as nurse educators to ensure that educators to ensure that

some public health some public health framework is included in framework is included in

curriculum at the Associate curriculum at the Associate Degree level?Degree level?

We bring some statistics to We bring some statistics to the attention of our the attention of our

students.students.

In a recent government In a recent government funded study at the Harvard funded study at the Harvard

School of Publlic Health, School of Publlic Health, Dr. Christopher Murray Dr. Christopher Murray

stated that the five counties stated that the five counties with the lowest life with the lowest life

expectancy were all in expectancy were all in South Dakota and three of South Dakota and three of the counties make up the the counties make up the

Pine Ridge Indian Pine Ridge Indian Reservation.Reservation.

Shannon, Bennett and Shannon, Bennett and Jackson Counties have a Jackson Counties have a 66.6 year life expectancy. 66.6 year life expectancy.

These are the counties that These are the counties that comprise Pine Ridge Indian comprise Pine Ridge Indian

reservation. Todd County reservation. Todd County part of Rosebud Indian part of Rosebud Indian

reservation has the same reservation has the same life expectancy.life expectancy.

In Clear Creek County in In Clear Creek County in neighboring Colorado a neighboring Colorado a

person can expect to live to person can expect to live to 81.3 years.81.3 years.

Even with the five counties Even with the five counties with the lowest life with the lowest life

expectancy in the US, South expectancy in the US, South Dakota placed 18Dakota placed 18thth in state in state

ranking with a life ranking with a life expectancy of 77.7.expectancy of 77.7.

What conclusions can be What conclusions can be drawn?drawn?

These are statistics that These are statistics that mean something to our mean something to our

students. This is home to students. This is home to most of them.most of them.

A brief introduction to A brief introduction to statistics helps these statistics helps these

students to interpret data students to interpret data that describes the that describes the

incidence of Type 2 incidence of Type 2 Diabetes, heart disease, Diabetes, heart disease, obesity, immune system obesity, immune system

disorders, cancer, suicide, disorders, cancer, suicide, depression and MVAsdepression and MVAs

They all have relatives with They all have relatives with at least one of these at least one of these

diseases.diseases.

Community Service Projects Community Service Projects that impact pieces of this that impact pieces of this morbidity and mortality.morbidity and mortality.

Creating an awareness Creating an awareness

An important piece of An important piece of service learning is the service learning is the

student’s reflections and student’s reflections and how it changed their lives how it changed their lives

and their view of their and their view of their communitycommunity

N. 218 Foundations of N. 218 Foundations of Holistic Nursing Care –Holistic Nursing Care –

Fall SemesterFall Semester• Each student will complete:Each student will complete:

10 hours- Case Study of elderly 10 hours- Case Study of elderly individual within the community- individual within the community- home or assisted living facilityhome or assisted living facility– Comprehensive health assessmentComprehensive health assessment– Nursing diagnosesNursing diagnoses– Assessment of medications and Assessment of medications and

environmentenvironment– Process recordingsProcess recordings

N. 224 Maternity N. 224 Maternity NursingNursing

• ““Shadow “visit with Community Shadow “visit with Community Health Nurse for Health Nurse for Postpartum/Newborn visitPostpartum/Newborn visit

• Nursing student then makes one Nursing student then makes one home visit on a new postpartum home visit on a new postpartum mother and her newborn and makes mother and her newborn and makes an assessment. an assessment.

SIDS, postpartum SIDS, postpartum depression,imunizationsdepression,imunizations

Nursing 234:Nursing 234: Students spend time Students spend time

serving in a nearby soup serving in a nearby soup kitchen and at the Pine kitchen and at the Pine

Ridge jailRidge jailfor this course on mental for this course on mental

health imbalanceshealth imbalances

ReflectionsReflections

In Nursing 324 the topic for In Nursing 324 the topic for the term paper must be the term paper must be taken from the Healthy taken from the Healthy People 2010 Objectives.People 2010 Objectives.

In this course focusing on In this course focusing on the wholistic health of the wholistic health of

children and their families, children and their families, the students must, in pairs the students must, in pairs or small groups, prepare or small groups, prepare

and present an educational and present an educational session to parents or the session to parents or the

targeted children targeted children concerning an area of risk concerning an area of risk to their health such as the to their health such as the prevention of tooth decay, prevention of tooth decay, promotion of self esteem, promotion of self esteem,

nutrition and activity, nutrition and activity, preventing STI’s, accidents preventing STI’s, accidents in the home or car safety.in the home or car safety.