POPULATION FOCUSED CARE Exam 1 Study Guide 2021| Nova Southeastern University

POPULATION FOCUSED CARE Exam 1 Study Guide 2021 “UPSTREAM THINKING” VS. TRADITIONAL HEALTHCARE INTERVENTIONS Upstream thinking considers the social, economic, and environmental origins of health problems (determinants of health) that manifest at the population level. The upstream thinking perspective is applied to an examination of environmentally associated health problems and the opportunities that citizens have (or do not have) to access information and resources to make health-promoting choices in response to environmental health risks. Upstream public thinking is the concept that preventing problems at the source (primary prevention) will help to reduce or prevent further problems “down the river” or in the future. Investing upstream in prevention rather than downstream in intervention is often wiser and more effective and is the essence of public health. It is macroscopic “big picture” population wide health approach. It considers determinants of health!! More traditional healthcare interventions focus on “downstream” thinking, or providing treatment to those with illness (secondary and tertiary) and the individual is the focus – not the community. They have a microscopic individual and curative focus, considering only individual health concerns and treatments. It doesn’t not consider sociopolitical, economic, and environmental variables. This is also less cost effective than upstream thinking. TYPES OF INTERVENTIONS WITH THE GREATEST IMPACT ON INCREASING LIFE EXPECTANCY Sanitation, epidemiology and nutrition are concepts that have had the greatest impact on increasing life expectancy. Public health itself and population focused care have extended longevity by preventing epidemics and the spread of disease, protecting against environmental hazards, preventing injuries, promoting and encouraging healthy behaviors, responding to disasters and assisting communities in recovery, and assuring the quality and accessibility of health services to those within a community. Types of interventions include vaccines, motor vehicle safety, safer and healthier foods, tobacco cessation, workplace safety, maternal and fetal health, and decreasing cardiovascular, heart, and stroke related deaths. LILLIAN WALD AND MARY BRECKENRIDGE’S CONTRIBUTIONS TO PUBLIC HEALTH Each nurse placed an emphasis on primary prevention. The history of health care and nursing provides examples of the advocacy of nursing in challenging settings with an unknown future. By considering the lessons of the past, nurses today and those in the future can find a profession well prepared to provide care with direction needed to focus of providing the full range of quality, cost effective services with promotion of health. These nurses contributed to improving health care access to all and reducing health care costs. Success of public health nursing depends on listening, being patient, providing accurate and sound info, and respecting experiences of community members. Lillian Wald pioneered public health by placing nurses in public schools, and helped found the National Organization for Public Health Nursing and Columbia University’s School of Nursing. Through the development of school nurses, primary prevention and EBP was utilized. There was a decreased chance of spreading diseases to healthy children, it provided a way to give ill children appropriate medical care they may not have received otherwise, disease was caught in earliest stages, and less school would be missed by sick children. She was an advocate for children, immigrants, labor, civil and women's rights through use of evidence based practice. She lobbied for inspections of the workplace and giving women the right to birth control. She also offered care to area residents in home on sliding scale. She founded the Henry Street Settlement, which later became the foundation for public health nursing in the United States, and aimed at rectifying those causes that led to poverty and misery. She coined the phrase “public health nursing” and transformed the narrow role of home visiting to the population focus of today’s community health nurse. Wald and the nurses she worked with set standards for the welfare of children and families for generations. They instituted procedures, applied Department of Health Standards for treatment, allowed for teaching of children and families, the improvement of the doctor/nurse relationship, and believed in confidentiality in order to maintain the patient’s and family’s dignity. Mary Breckenridge was important in establishing the concept of nursing WITH the community, meaning the health agenda originates from within the community as opposed to being imposed by others. There is a shared vision of health. Breckenridge specifically helped organize the first midwifery service in the US – Frontier Nursing Service. With this service, she rode with her other nurses on horseback to those families in need who couldn’t travel to help themselves during WWII. They successfully lowered the highest maternal mortality rates in the US to below the national average. POPULATION-FOCUSED NURSING Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. It is a specialty practice within nursing and public health, focusing on improving population health by emphasizing prevention and attending to multiple determinants of health. It is often using interchangeably with community health nursing. It assesses the health care needs of a specific population and makes healthcare decisions for the population as a whole rather than individually. It also considers multiple levels of prevention with preference for primary prevention. This nursing practice includes advocacy, policy development, and planning, which addresses issues of social justice. With a multi-level view of health, public health nursing action occurs through community applications of theory, evidence, and commitment to health equity. While the discipline of nursing was founded on improving environmental conditions to facilitate health at the bedside, public health nurses focus on improving population health within the environments where people live, work, learn, and play. Key Characteristics of Public Health Nursing: 1. A focus on the health needs of an entire population a. Includes inequities and the unique needs of subpopulations 2. Assessment of population health using a comprehensive, systematic approach 3. Attention to multiple determinants of health 4. An emphasis on primary prevention 5. Application of interventions at all levels a. Individuals, families, communities, and the systems that impact their health Public health nursing aims to improve the health outcomes of all populations. Applying their clinical knowledge and expertise in health care from an ecological perspective, public health nurses acknowledge the complexity of public health problems and the contextual nature of health—including cultural, environmental, historical, physical, and social factors. Public health nurses apply systems-level thinking to assess the potential or actual assets, needs, opportunities, and inequities of individuals, families, and populations and translate this assessment into action for public good. Public health nurses are obligated to actively identify and reach out to all who might benefit from a specific activity or service. ECOLOGICAL HEALTH MODEL It is a model of health that emphasizes the linkages and relationships among multiple individual and population- level factors, or determinants, affecting health. Factors range from the micro level to the macro level. • Intrapersonal factors: genetics, individual behaviors and characteristics, self-concept, developmental history, knowledge, attitude, and individual skills. Includes gender, religious identity, race/ethnicity, sexual orientation, economic status, financial resources, values, goals expectations, age, genetics, resiliency, coping skills, time management skills, health literacy, access to health care skills, etc. • Interpersonal factors: formal and informal social networks and support systems, including family characteristics, friends, work groups, etc. • Institutional factors: social institutions with organizational characteristics and formal or informal rules and regulations for operation. Includes community climate (tolerance/intolerance), schedules, financial policies, lighting, unclean/clean environments, distance from one place to another, air quality, safety, etc. • Community environment factors: built environment where individuals live and work and includes land use, zoning, community design, modes of transportation, and available physical activity options. Includes relationships between organizations, institutions, and informational networks within defined boundaries. May include location in the community, built environment, neighborhood associations, community leaders, businesses, walkability, transportation, parks, etc. • Public policy factors: global, national, state, and local laws and regulations. Includes policies that allocate resources to establish and maintain a coalition that serves a mediating relationship connecting individuals and the larger social environment These are important in public health because they organize thinking, guide interventions, and evaluate the effects of interventions. This is a framework for determinants of health (policy making, social factors, health services, individual behavior, biology and genetics). You need to understand the “big” picture before trying to understand the smaller details – examine the larger context that creates a health problem! ......continued**