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Copyright © 2008 Delmar. All rights reserved.
Chapter 3
Practice Settings in Public Health Nursing
Copyright © 2008 Delmar. All rights reserved.
2
Historical Practice Perspectives
• Visiting nurses (1877) funded by philanthropists– Purpose was to restore, promote health, and
prevention of disease
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3
Historical Practice Perspectives
• Lillian Wald – Public health founder– Nurses’ Settlement House
• Henry Street Settlement
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4
Practice Settings in Governmental or Official Agencies
• Public Health Service (PHS) 1798– U.S. Department of Health and Human
Services (HHS)• Protects the health of Americans• Provides health services for those who lack
resources
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5
Practice Settings in Governmental or Official Agencies• Made up of 11 operating division that fall
into two categories– Public Health Service Operating Division – Human Services Operating Division
• Nurses may work in any division
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Practice Settings in Governmental or Official Agencies
• Commissioned Corps– Work to advance the health of Americans and
improve delivery of services• Direct care provider • Supervisor• Consultant• Researcher and Administrator
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7
State and Local Public Health Agencies
• State health departments perform needs assessment of the population – Identify Healthy People 2010 objectives
• Local health agencies– Provide direct personal services for those
dependent on government assistance
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School Nursing
• Wald established school nursing in 1902– Proposed an experiment to decrease
absenteeism rate – Successful experiment
• 90 percent drop in rate
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9
School Nursing
• School nurse challenges today:– Communicable diseases– Poverty– Hunger– Poor home and community environment
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Screenings
• Children with asthma, diabetes, obesity, learning disabilities, violence, STDs, addiction
• School nurses may be employed by: – Public health agencies– Hospitals– Local school board
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School Nurse Role
• Care provider• Health educator• Counselor• Case manager• Health promoter
• Collaborator• Healthy policy expert• Advocate• Researcher
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School Nurse Conducts
• Hearing screens• Vision screens• Scoliosis screens• Immunizations• Medication
administration
• Delegated medical functions
• First aid• Emergency
procedures• Health education
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13
School-Based Centers
• Primary care centers located on school grounds– Nurse practitioners are primary care providers– Provide preventive services
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14
Nongovernmental, Community Agency Practice Settings
• Primary care centers– Primary health care– Primary care
• Community health centers– Safety net provider– Partially funded by federal grant program
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Nongovernmental, Community Agency Practice Settings
• Improve access to health services to medically underserved– Required to serve all residents– Offer sliding scale fee – Governed by board of members
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Nongovernmental, Community Agency Practice Settings
• Homeless clinics– Safety net provider– Receive federal funds
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Nongovernmental, Community Agency Practice Settings
• May be sponsored by:– Public health agencies – Hospitals – Community coalitions– Academic health centers– Universities– Faith-based organizations
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Nongovernmental, Community Agency Practice Settings
• Homeless clinics provide:– Primary care – Behavioral services – Substance abuse counseling – Case management
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19
Rural Health Clinics (RHC)
• Rural Health Clinic Services Act (1977)– Safety net provider, increases accessibility,
and availability to primary care services– Allowed RHC to receive cost based Medicare
and Medicaid reimbursement – Assist with delivery of personal care services
for prevention, and acute and chronic services
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20
Rural Health Clinics (RHC)
• Rural populations have an older population – Higher rate of chronic illness – Higher rate of poor health behaviors
• Challenges– Obtaining and retaining providers
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21
Migrant Health Centers
• Safety net provider
• Operated by nonprofit agencies to:– Improve accessibility to culturally linguistic
primary care– Improve availability to culturally linguistic
primary care
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Nurse Managed Health Centers
• Safety net provider when primary mission is to provide accessible health services
• Managed and directed by nurses
• Challenges– Sufficient resources – Revenue for expenditures
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23
Faith-Based Organizations
• Made up of those who share a common spiritual or religious faith
• May take place in: – Churches– Synagogues/Cathedrals– Temples/Mosques– Other buildings used by faith community
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24
Faith-Based Organizations
• Parish nurses– Specialty practice– Scope and standards of practice for parish
nurses– Provide holistic care within the context of the
religious community
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25
Workplace
• Vermont Marble Company 1900s– Coal Miners, WWII
• Various occupational settings today
• Specialty practice that focuses on:– Health promotion– Disease and injury prevention– Restoration of health and safe environment
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Workplace
• May be employed by company or contracted independently
• Roles of the occupational health nurse:– Clinician– Case manager– Coordinator – Manager
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Workplace
• Nurse practitioner– Corporate director– Health promotion specialist– Educator – Consultant– Researcher
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Home Visiting
• Home visiting– Subspecialty of community health nursing– Nurses provide skilled care to homebound
individuals– Focus on restorative care
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Other Settings
• Correctional facilities– Federal prisons– County jails
• Community mental health centers
• Senior centers
• Adult day care
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Models of PublicHealth Nursing Practice
• Minnesota Department of Health, Public Health Section “Intervention Wheel”– Identifies 17 interventions clustered into five
groups: • Surveillance• Referral and follow-up• Health teaching• Collaboration• Advocacy
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Other Models
• State and Territorial Directors of Nursing Public Health Nursing Practice Model– Developed in 1994 by Public Health
Functions Steering Committee– Model links core public health functions
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Other Models
• Los Angeles County Public Health Nursing Practice Model– Developed by public health nurses– Blends national standards and components– Emphasizes primary prevention
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Other Models
• Components – Scope and Standards of Public Health
Nursing Practice– Ten Essential Public Health Services– Healthy People 2010 indicators– Intervention Wheel
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Issues and Challenges
• Workforce shortage
• Insufficient funds
• Recruit and retain public health forces
• Insufficient number of baccalaureate level nurses
• Less than competitive salaries
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