Public Health Nursing

Public Health Nursing Najwa Subuh- MSN in Pediatric

Public health nursing is a specialized form of registered nursing that combines nursing & public health principles. • The primary focus of PHN is improving the health of the community as a whole rather than just that of an individual or family. PHN is sometimes called a type of CHN. Some experts use the terms “PHN & CHN" interchangeably. Najwa Subuh- MSN in Pediatric

What is a Public Health Nurse? • Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences.” • “PHN is a field of nursing that combines public health with nursing, is population oriented, emphasizes health, involves interdisciplinary collaboration, focuses on the entire population.” • INTERVENTIONS are actions that public health nurses take on behalf of individuals, families, and communities. • The public health core functions of assessment, policy development, & assurance are fulfilled through activities and interventions that are based on community need. Najwa Subuh- MSN in Pediatric

PHN is a systematic process 1. The health and health care needs of a population are assessed in order to identify subpopulations, families and individuals who would benefit from health promotion or who are at risk of illness, injury, disability or premature death. 2. A plan for intervention is developed with the community to meet identified needs that take into account available resources, the range of activities that contribute to health and the prevention of illness injury, disability, and premature death. The plan is implemented effectively, efficiently and equitably. 3. Evaluations are conducted to determine the extent to which the intervention has an impact on the health status of individuals and the population. 4. The results of the process are used to influence and direct the current delivery of care, deployment of health resources, and the development of local, regional, state, and national health policy and research to promote health and prevent disease. Najwa Subuh- MSN in Pediatric

The systematic process is based on & consistent with: 1. Community strengths, needs and expectations; 2. Current scientific knowledge; 3. Available resources; 4. Accepted criteria and standards of nursing practice; 5. Agency purpose, philosophy and objectives 6. The participation, cooperation, and understanding of the population. Najwa Subuh- MSN in Pediatric

ROLE OF PUBLIC HEALTH NURSES • PHN integrate community involvement and knowledge about the entire population with personal, clinical understandings of the health and illness experiences of individuals and families within the population. • They translate and articulate the health and illness experiences of diverse, often vulnerable individuals and families in the population to health planners and policy makers, and assist members of the community to voice their problems and aspirations. Public health nurses are knowledgeable about multiple strategies for intervention, from those applicable to the entire population, to those for the family, and the individual. • PHN translate knowledge from the health and social sciences to individuals and population groups through targeted interventions, programs, and advocacy. Public health nursing may be practiced by one public health nurse or by a group of public health nurses working collaboratively. In both instances, public health nurses are directly engaged in the inter-disciplinary activities of the core public health functions of assessment, assurance and policy development. Interventions or strategies may be targeted to multiple levels depending on where the most effective outcomes are possible. • They include strategies aimed at entire population groups, families, or individuals. In any setting, the role of public health nurses focuses on the prevention of illness, injury or disability, the promotion of health, and maintenance of the health of populations. Najwa Subuh- MSN in Pediatric

Examples of PHN Activities 1. Evaluating health trends and risk factors of population groups and helping to determine priorities for targeted interventions. 2. Working with communities or specific population groups within the community to develop public policy and targeted health promotion and disease prevention activities. 3. Participating in assessing and evaluating health care services to ensure that people are informed of available programs and services and assisted in the utilization of those services. 4. Providing essential input to interdisciplinary programs that monitor, anticipate, and respond to public health problems in population groups. 5. Providing health education, care management, and primary care to individuals and families who are members of vulnerable population and high-risk groups. Najwa Subuh- MSN in Pediatric

Public health nurses provide a critical linkage between epidemiological data and clinical understanding of health and illness as it is experienced in peoples’ lives. • This understanding is translated into action for the public good. An illustration of this role is the surveillance and monitoring of disease trends within the community. Emerging patterns that potentially threaten the public’s health are identified and appropriate interventions planned, coordinated and implemented. • This is a role that public health nurses can do in any setting; however, it occurs mainly in the public sector. PHN contribute to systems for monitoring crucial health status indicators such as environmentally caused illnesses, immunization levels, infant mortality rates, and communicable disease occurrence, in order to identify problems that threaten the public’s health and develop effective interventions. Najwa Subuh- MSN in Pediatric

TENETS OF PHN • Population-based assessment, policy development, and assurance processes are systematic and comprehensive. The client or unit of care is the population. Each process includes consideration of the community capacity, personal or lifestyle health practices, human biology, health services, and social, economic, physical, and environmental factors as they affect the population’s health. • The assessment process includes a review of the needs, strengths, and expectations of all of the people and is guided by epidemiological methods. Policies are derived from assessment, are developed with a view toward the priorities set by the people, & consider subpopulations or communities where health is at greatest risk, as well as the effectiveness of interventions and program options in influencing the health goals of the people. • Interventions and programs are assured through direct provision of services by public health nurses, through regulation, or by encouraging the actions of other health care professionals or organizations, and focus on availability, acceptability, access, and quality of services. Najwa Subuh- MSN in Pediatric

TENETS OF PHN 2. All processes must include partnering with representatives of the people. This assures that the interpretation of the data, policy decisions, and planning of intervention strategies reflect the perspectives, priorities, and values of the people. By emphasizing representation from multiple communities, decisions are made with consideration of what is in the best interest of all. 3. Primary prevention is given priority. Primary prevention includes health promotion and health protection strategies. The practice of public health nursing places emphasis on primary prevention in all assessment, policy development, and assurance processes. Najwa Subuh- MSN in Pediatric

TENETS OF PHN • They would argue that there is the mistaken perception of public health nurses as providers of personal care only. The challenge for public health nurses in the future is to apply the nursing process (assessment, diagnosis, planning, implementation, and evaluation of interventions) to improve health, not just of individuals, but also with larger segments of the population in partnership with the community. • Provide input to interdisciplinary programs that monitor, anticipate and respond to health problems in population groups for all diseases or public health threats including bioterrorism • Evaluate health trends and risk factors of population groups to help determine priorities forming targeted interventions • Work with the community or specific population groups to develop targeted health promotion and disease prevention activities • Evaluate health care services • Provide health education, care, management and primary care to individuals and families who are members of vulnerable populations and high risk groups Najwa Subuh- MSN in Pediatric

What Does PHC Do Today? • The complete description for public health practice has yet to be written. The simplest and most straightforward depiction of what public health practice is all about today is best illustrated in the mission, vision, and functions. • This one-page document was developed to become the hymnal from which all public health practitioners would sing in the twenty-first century. • The statement articulates a vision (healthy people in healthy communities), a mission (promoting physical and mental health and preventing disease, injury, and disability), and statements of what public health practice does and how it accomplishes those ends. Six broad commitments characterize what public health does. Najwa Subuh- MSN in Pediatric

What Does PHC Do Today? • Prevents epidemics and the spread of disease. • Protects against environmental hazards. • Prevents injuries. • Promotes and encourages healthy behaviors. • Responds to disasters and assists communities in recovery. • Assures the quality and accessibility of health services. • How public health practice accomplishes these objectives and serves its mission is characterized by ten essential public health services that seek to: • Monitor health status to identify community health problems. • Diagnose and investigate health problems and health hazards in the community. • Inform, educate, and empower people about health issues. • Mobilize community partnerships to identify and solve health problems. • Develop policies and plans that support individual and community health efforts. • Enforce laws and regulations that protect health and ensure safety. • Link people to needed personal health services and assure the provision of health care when otherwise unavailable. • Assure a competent public and personal health care work force. • Evaluate effectiveness, accessibility, & quality of personal. , & population-based health services. • Provide research for new insights and innovative solutions to health problems. Najwa Subuh- MSN in Pediatric

Essential public health services that seek to • Monitor health status to identify community health problems. • Diagnose and investigate health problems and health hazards in the community. • Inform, educate, and empower people about health issues. • Mobilize community partnerships to identify & solve health problems. • Develop policies and plans that support individual and community health efforts. • Enforce laws and regulations that protect health and ensure safety. • Link people to needed personal health services and assure the provision of health care when otherwise unavailable. • Assure a competent public and personal health care work force. • Evaluate effectiveness, accessibility, and quality of personal. and population-based health services. • Provide research for new insights and innovative solutions to health problems. Najwa Subuh- MSN in Pediatric

What Challenges Does Public Health Practice Face in the Year 2001 and Beyond? • Public health practice faces many challenges. There are scores of continuing health problems (such as cancer and injuries), emerging health problems (such as AIDS and violence), and re-emerging ones (such as TB), and a slew of new issues on the public health practice agenda. • While health status has never been better (as measured by life expectancy and infant mortality), the gains have not been shared equally by all segments of the population. • Despite the most expensive and effective medical services in the world, health status gains have not kept pace with immense investments and the United States health system continues to focus on illness rather than health. These unacceptable realities challenge public health practitioners' core values of realizing public health's dream of social justice and creating a health system organized around health. Najwa Subuh- MSN in Pediatric

To meet the challenges, public health practice will have to relearn the lessons of its past and move to expand its circle to include new sectors of society at every level of government—namely, more community partners and stakeholders and a more involved citizenry. • In sum, further improvements in health status that eliminate disparities in outcomes remains the greatest challenge to the practice of public health. • A continuing commitment to realize the dream of social justice in health will, in all probability, continue to drive public health practice in the twenty-first century. Najwa Subuh- MSN in Pediatric

PUBLIC HEALTH – MAIN AIMS • The mission of public health is to "fulfil society's interest in assuring conditions in which people can be healthy." The three core public health functions are: • The assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities • The formulation of public policies designed to solve identified local & national health problems & priorities • To assure that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care. Najwa Subuh- MSN in Pediatric

PUBLIC HEALTH FUNCTIONS • Health surveillance, monitoring and analysis • Investigation of disease outbreaks, epidemics and risk to health • Establishing, designing and managing health promotion and disease prevention programmes • Enabling and empowering communities to promote health and reduce inequalities • Creating and sustaining cross-Government and intersectoral partnerships to improve health and reduce inequalities • Ensuring compliance with regulations and laws to protect and promote health • Developing and maintaining a well-educated and trained, multi-disciplinary public health workforce • Ensuring the effective performance of NHS services to meet goals in improving health, preventing disease and reducing inequalities • Research, development, evaluation and innovation • Quality assuring the public health function Najwa Subuh- MSN in Pediatric

Social determinants of health Najwa Subuh- MSN in Pediatric

Social determinants of health are the economic and social conditions under which people live which determine their health. They are social risk factors, either increasing or decreasing the risk for a disease, for example for cardiovascular disease and type II diabetes. • "Social determinants of health are the economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole. Social determinants of health are the primary determinants of whether individuals stay healthy or become. • Social determinants of health also determine the extent to which a person possesses the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment. Najwa Subuh- MSN in Pediatric

Social determinants of health WHO influence: • Income and social status • Social support networks • Education and literacy, i.e. health literacy • Employment/Working conditions • Social environments • Physical environments • Life skills • Personal health practices and coping skills • Healthy child development • Biology and genetic endowment • Health services • Gender • Culture Najwa Subuh- MSN in Pediatric

"Social justice is a matter of life & death. It affects the way people live, their consequent chance of illness, & their risk of premature death. We watch in wonder as life expectancy & good health continue to increase in parts of the world and in alarm as they fail to improve in others. • These inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, & economic forces. Najwa Subuh- MSN in Pediatric

Social and economic policies have a determining impact on whether a child can grow and develop to its full potential and live a flourishing life, or whether its life will be blighted. Increasingly the nature of the health problems rich and poor countries have to solve are converging. • The development of a society, rich or poor, can be judged by the quality of its population’s health, how fairly health is distributed across the social spectrum, and the degree of protection provided from disadvantage as a result of ill-health. Najwa Subuh- MSN in Pediatric

What are social determinants of health? • The term “social determinants of health” grew out of researchers' search for the specific mechanisms by which members of different socio-economic groups come to experience varying degrees of health and illness. Everywhere, individuals of different socio-economic status show profoundly different levels of health and incidence of disease. • Another stimulus to investigating social determinants of health was the finding of national differences in population health. For example, the health status of Americans—using indicators such as life expectancy, infant mortality, and death by childhood injury rates—compares unfavourably to citizens in most industrialized wealthy nations. Najwa Subuh- MSN in Pediatric

What are social determinants of health? • In contrast, the health status of Scandinavians is generally superior to that seen in most nations. It was hypothesized that perhaps the same factors that explain health differences among groups within nations could also explain differences among national populations. • The Ottawa Charter for Health Promotion identifies the prerequisites for health as peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity. • Income and social status, social support networks, education, employment & working conditions, physical & social environments, biology and genetic endowment, personal health practices and coping skills, healthy child development, gender, culture, and health services Najwa Subuh- MSN in Pediatric

The traditional 10 Tips for Better Health • 1. Don't smoke. If you can, stop. If you can't, cut down. • 2. Follow a balanced diet with plenty of fruit and vegetables. • 3. Keep physically active. • 4. Manage stress by, for example, talking things through and making time to relax. • 5. If you drink alcohol, do so in moderation. • 6. Cover up in the sun, and protect children from sunburn. • 7. Practice safer sex. • 8. Take up cancer-screening opportunities. • 9. Be safe on the roads: follow the Highway Code. • 10. Learn the First Aid ABCs: airways, breathing, circulation. Najwa Subuh- MSN in Pediatric

The social determinants 10 Tips for Better Health 1. Don't be poor. If you can, stop. If you can't, try not to be poor for long. 2. Don't have poor parents. 3. Own a car. 4. Don't work in a stressful, low-paid manual job. 5. Don't live in damp, low-quality housing. 6. Be able to afford to go on a foreign holiday and sunbathe. 7. Practice not losing your job & don't become unemployed. 8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled. 9. Don't live next to a busy major road or near a polluting factory. 10. Learn how to fill in the complex housing benefits before you become homeless and destitute. Najwa Subuh- MSN in Pediatric

Public policy • Much social determinants of health research simply focuses on determining the relationship between a social determinant of health and health status. So a researcher may document that lower income is associated with adverse health outcomes among parents & their children. • Or a researcher may demonstrate that food insecurity is related to poor health status among parents and children as is living in crowded housing, and so on. This is what is termed a depoliticized approach in that it says little about how these poor-quality social determinants of health come about. Najwa Subuh- MSN in Pediatric

Public policy • Social determinants of health do not exist in a vacuum. Their quality and availability to the population are usually a result of public policy decisions made by governing authorities. As one example, consider the social determinant of health of early life. • Early life is shaped by availability of sufficient material resources that assure adequate educational opportunities, food and housing among others. Much of this has to do with the employment security and the quality of working conditions and wages. • The availability of quality, regulated childcare is an especially important policy option in support of early life. These are not issues that usually come under individual control. A policy-oriented approach places such findings within a broader policy context. Najwa Subuh- MSN in Pediatric

Politics and political ideology • One way to think about this is to consider the idea of the welfare state and the political ideologies that shape its form in Canada and elsewhere. The concept of the welfare state is about the extent to which governments – or the state – use their power to provide citizens with the means to live secure and satisfying lives. Every developed nation has some form of the welfare state. • Social democratic nations have very well developed welfare states that provide a wide range of universal and generous benefits. They expend more of national wealth to supports and services. Najwa Subuh- MSN in Pediatric

Politics and political ideology • They are proactive in developing labour, family-friendly, and gender equity supporting policies. Liberal nations spend rather less on supports and services. They offer modest universal transfers and modest social-insurance plans. Benefits are provided primarily through means-tested assistance whereby these benefits are only provided to the least well-off. • Navarro & colleagues provide empirical support for the hypotheses that the social determinants of health & health status outcomes are of higher quality in the social democratic rather than the liberal nations. • Some of these indicators are spending on supports and services, equitable distribution of income, and wealth and availability of services in support of families and individuals. Health indicators include life expectancy and infant mortality. Najwa Subuh- MSN in Pediatric

Najwa Subuh- MSN in Pediatric

Public Health Nursing