Population Health

Population Health

Population health​ is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”​ ​(Kindig & Stoddart, 2003, p. 381). Population health has a goal of measuring, intervening, and improving health disparities among groups, as well as the distribution of health, all of which is driven by assessment and statistical data. ​Public health​, a subcomponent of population health,​ ​is the practice of protecting and promoting quality of life and holistic health of persons and communities through the use of science, research, and direct care. The American Public Health Association (APHA) defines ​public health nursing​ as “the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences” (American Public Health Association [APHA], 2013, p. 2). Interdisciplinary public health practices aim to prevent disease outbreaks, injuries, and poor health while promoting cost-effective measures that improve quality of life and health as well as reduce environmental hazards (APHA, n.d.; Centers for Disease Control and Prevention Foundation, 2017). Population Health

Development of the Public Health Nursing Role

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The historical path leading to the discipline of public/community health nursing began more than a century ago. Several nursing pioneers fashioned programs that led to the development of organized public health delivery.

● Florence Nightingale initiated “health visitors” in 1892, a group composed of lay female missionaries with specialized training for instruction of health (Buhler-Wilkinson, 1985). Much of the focus was teaching women about caring for themselves and their children. This was the foundation of England’s district nursing today.

● Lillian Wald established the term ​public health nurse​ with a focus on treating social and economic problems along with illness. In 1893, Wald and Mary Brewster put this belief into practice on the Lower East Side tenements of New York. Two years later, this led to the establishment of the Henry Street Settlement and, later, the development of the Visiting Nurses Association (VNA) (Fee & Bu, 2010). Population Health

● Mary Breckinridge introduced nurse midwifery to the United States in 1925. She traveled on horseback to deliver modern health care to the most inaccessible and poorest areas of Appalachia in Kentucky (Frontier Nursing Service, 2015). This lead to the subsequent development of the Frontier Nursing Service (FNS) and the expansion of public health nursing into remote rural areas (Frontier Nursing University, n.d.).

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Policy Reform The public health profession continues to evolve. Various policy reforms in the United States have shaped public health nursing to become what it is today. Public health needs drive development of programs to improve public health. Sanitation reforms occurred as public health nursing emerged. Public health education, improved waste disposal methods, and clean-water policies reinforced the importance of the environment to the nation’s health. In 2004, a presidential order, signed by President George W. Bush, established the Office of National Coordinator for Health Information Technology, which included incentives for providers using health information technology (HIT), motivating them to utilize electronic medical records (Bush, 2004; DeSalvo, Dinkler, & Stevens, 2015). Timely and efficient access to patient-related information ushered in a new era of health informatics and population health. The 2010 Affordable Care Act (ACA) reinforced the importance of the use of HIT. Gradual transition of services to outpatient or community settings further reinforce the nurse’s role in population health management and health information technology. Population Health

From public health nursing, subspecialties have emerged, including school nursing, industrial and occupational health nursing, child health nursing, tuberculosis nursing, rural nursing, and the American Red Cross. Born from the rise of nursing specialty interest groups, the National Organization of Public Health Nursing (NOPHN) emerged with Lillian Wald as the first president. Many groups have since formed to address the varying needs of nurses across settings and clinical specialties, including the American Nurses Association (ANA). The ANA, the largest nursing organization, represents nurses across the United States, reinforcing the role of public health nursing. The ANA recognizes and promotes the Quad Council Coalition of Public Health Nursing Organizations (QCC or Quad Council) and public health nursing’s scope and standards of practice. The ANA also supports nursing involvement in public health advocacy, education, and policy, along with evolving health issues (American Nurses Association [ANA], n.d.). Population Health

Quad Council Coalition

The QCC comprises four nursing organizations serving public health nursing. Current

members include the Alliance of Nurses for Healthy Environments (ANHE), Public

Health Nursing Section of the American Public Health Association (PHN Section of

APHA), the Association of Community Health Nurse Educators (ACHNE), and the

Association of Public Health Nurses (APHN) (Quad Council Coalition of Public Health

Nursing Organizations [QCC], n.d.). Population Health

The QCC is the vehicle for guiding and developing current critical components and

competencies. Beginning in 2011, the QCC competencies were aligned to the ​Core

Competencies for Public Health Professions​, a guiding document the QCC developed to

bridge academic and public health practice (Public Health Foundation, n.d.; QCC, n.d.;

Swider, Krothe, Reyes, & Cavetz, 2013). This alignment provided a mechanism to

promote nursing evidence-based competencies congruent with other public health

professions and academic practices. The nursing competencies span three tiers of

practice over various skill domains with competencies. The three tiers categorize

practice as:

● Tier 1-basic or generalist ● Tier 2-specialist or midlevel ● Tier 3-executive and/or multi-systems level (Swider et al., 2013).

Those at the Tier 1 level work directly with the diverse populations to promote health

and prevent disease, collect and analyze data, plan programs, and conduct outreach

activities to reduce health disparities (QCC, n.d.). Tier 2 public health nurses are in

management or supervisory roles and assist in implementation of public health

programs (QCC, n.d.). Tier 3 competencies are for senior management or nurse

executive roles. Tier 3 public health nurses are responsible for administration,

organization, and operation of public health programs (QCC, n.d.). Population Health

Today’s Community and Public Health Nurses

● Health promotion and care for the community and population at large reflect public/community health nurses’ mission, ​vision​, and ​commitments​. ​Community health nursing​ and public health nursing are terms synonymous for the role of the nurse outside institutional settings; however, the terms are distinct from each other. Community health nursing has traditionally focused on nursing care for acute and chronic conditions outside the traditional hospital setting, primarily involving restorative care. Now, community health nursing involves health promotion of individuals and families, providing care in settings such as occupational or educational systems. Public health nursing addresses health promotion beyond an individual’s or family’s needs, incorporating community aspects and global or environmental concerns. Public health nursing focuses on groups, populations, or the health of an entire geographical sector (Canales & Drevdahl, 2014; Kulbok, Thatcher, Park, & Meszaros, 2012; Reifsnider & Garcia, 2015). Public health nursing is a ​population-focused​ practice. This practice concentrates on the defined population’s needs for prevention of illness and health improvement (Association of Public Health Nurses [APHN], n.d.; ANA, n.d.; APHA, 2013). A public health nurse (PHN) incorporates dynamics extending to small groups, or ​aggregates​, and beyond for improvement of a population’s overall health. In turn, this improves the health of individuals and families’ living, employment, and recreational environments (Swider & Kulbok, 2015). Aggregates are persons who are grouped together because of common characteristics or location. The PHN’s educational background is traditionally a baccalaureate or advanced practice level (Reifsnider & Garcia, 2015). To a nurse providing inpatient or primary care, a population means the patients who are within that setting, but for a PHN, the population is inclusive of the entire aggregate living in the community or a larger geographic sector. The PHN’s population shares commonalities of disease and risk and, unlike patients in an inpatient setting, the population Population Health

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comprises all persons irrespective of whether they request services (Reifsnider & Garcia, 2015). Most nurses practice at individual and interpersonal levels of a community, but PHNs practice at the organizational, community, and public policy levels as well. The PHN collaborates with other disciplines and key community ​stakeholders​. These stakeholders are persons who are both involved and directly affected by the plans, actions, and outcomes of population health care. For example, stakeholders may be local government officials, community groups, faith-based organizations, or local business owners Population Health

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