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

2. 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

3. Copyright © 2008 Delmar. All rights reserved. 3 Historical Practice Perspectives Lillian Wald –Public health founder –Nurses’ Settlement House Henry Street Settlement

4. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 8 School Nursing Wald established school nursing in 1902 –Proposed an experiment to decrease absenteeism rate –Successful experiment 90 percent drop in rate

9. Copyright © 2008 Delmar. All rights reserved. 9 School Nursing School nurse challenges today: –Communicable diseases –Poverty –Hunger –Poor home and community environment

10. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 11 School Nurse Role Care provider Health educator Counselor Case manager Health promoter Collaborator Healthy policy expert Advocate Researcher

12. Copyright © 2008 Delmar. All rights reserved. 12 School Nurse Conducts Hearing screens Vision screens Scoliosis screens Immunizations Medication administration Delegated medical functions First aid Emergency procedures Health education

13. Copyright © 2008 Delmar. All rights reserved. 13 School-Based Centers Primary care centers located on school grounds –Nurse practitioners are primary care providers –Provide preventive services

14. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 15 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

16. Copyright © 2008 Delmar. All rights reserved. 16 Nongovernmental, Community Agency Practice Settings Homeless clinics –Safety net provider –Receive federal funds

17. Copyright © 2008 Delmar. All rights reserved. 17 Nongovernmental, Community Agency Practice Settings May be sponsored by: –Public health agencies –Hospitals –Community coalitions –Academic health centers –Universities –Faith-based organizations

18. Copyright © 2008 Delmar. All rights reserved. 18 Nongovernmental, Community Agency Practice Settings Homeless clinics provide: –Primary care –Behavioral services –Substance abuse counseling –Case management

19. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 26 Workplace May be employed by company or contracted independently Roles of the occupational health nurse: –Clinician –Case manager –Coordinator –Manager

27. Copyright © 2008 Delmar. All rights reserved. 27 Workplace Nurse practitioner –Corporate director –Health promotion specialist –Educator –Consultant –Researcher

28. Copyright © 2008 Delmar. All rights reserved. 28 Home Visiting Home visiting –Subspecialty of community health nursing –Nurses provide skilled care to homebound individuals –Focus on restorative care

29. Copyright © 2008 Delmar. All rights reserved. 29 Other Settings Correctional facilities –Federal prisons –County jails Community mental health centers Senior centers Adult day care

30. Copyright © 2008 Delmar. All rights reserved. 30 Models of Public Health 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 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. Copyright © 2008 Delmar. All rights reserved. 33 Other Models Components –Scope and Standards of Public Health Nursing Practice –Ten Essential Public Health Services –Healthy People 2010 indicators –Intervention Wheel

34. Copyright © 2008 Delmar. All rights reserved. 34 Issues and Challenges Workforce shortage Insufficient funds Recruit and retain public health forces Insufficient number of baccalaureate level nurses Less than competitive salaries