Copyright © 2008 Delmar. All rights reserved. Chapter 3 Practice Settings in Public Health Nursing

Copyright © 2008 Delmar. All rights reserved.

Chapter 3

Practice Settings in Public Health Nursing


2

Historical Practice Perspectives

• Visiting nurses (1877) funded by philanthropists– Purpose was to restore, promote health, and

prevention of disease


3

Historical Practice Perspectives

• Lillian Wald – Public health founder– Nurses’ Settlement House

• Henry Street Settlement


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


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


6

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


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


8

School Nursing

• Wald established school nursing in 1902– Proposed an experiment to decrease

absenteeism rate – Successful experiment

• 90 percent drop in rate


9

School Nursing

• School nurse challenges today:– Communicable diseases– Poverty– Hunger– Poor home and community environment


10

Screenings

• Children with asthma, diabetes, obesity, learning disabilities, violence, STDs, addiction

• School nurses may be employed by: – Public health agencies– Hospitals– Local school board


11

School Nurse Role

• Care provider• Health educator• Counselor• Case manager• Health promoter

• Collaborator• Healthy policy expert• Advocate• Researcher


12

School Nurse Conducts

• Hearing screens• Vision screens• Scoliosis screens• Immunizations• Medication

administration

• Delegated medical functions

• First aid• Emergency

procedures• Health education


13

School-Based Centers

• Primary care centers located on school grounds– Nurse practitioners are primary care providers– Provide preventive services


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


15


• Improve access to health services to medically underserved– Required to serve all residents– Offer sliding scale fee – Governed by board of members


16


• Homeless clinics– Safety net provider– Receive federal funds


17


• May be sponsored by:– Public health agencies – Hospitals – Community coalitions– Academic health centers– Universities– Faith-based organizations


18


• Homeless clinics provide:– Primary care – Behavioral services – Substance abuse counseling – Case management


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


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


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


22

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


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


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


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


26

Workplace

• May be employed by company or contracted independently

• Roles of the occupational health nurse:– Clinician– Case manager– Coordinator – Manager


27

Workplace

• Nurse practitioner– Corporate director– Health promotion specialist– Educator – Consultant– Researcher


28

Home Visiting

• Home visiting– Subspecialty of community health nursing– Nurses provide skilled care to homebound

individuals– Focus on restorative care


29

Other Settings

• Correctional facilities– Federal prisons– County jails

• Community mental health centers

• Senior centers

• Adult day care


30

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


31

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


32

Other Models

• Los Angeles County Public Health Nursing Practice Model– Developed by public health nurses– Blends national standards and components– Emphasizes primary prevention


33

Other Models

• Components – Scope and Standards of Public Health

Nursing Practice– Ten Essential Public Health Services– Healthy People 2010 indicators– Intervention Wheel


34

Issues and Challenges

• Workforce shortage

• Insufficient funds

• Recruit and retain public health forces

• Insufficient number of baccalaureate level nurses

• Less than competitive salaries

Documents

Copyright © 2008 Delmar. All rights reserved. Chapter 3 Practice Settings in Public Health Nursing