learning objectives overview of...

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Public Health Nurse Orientation

Module 3

Services to Prevent ChronicDiseases and Injuries

Public Health Nurse OrientationServices to Prevent Chronic Diseases and Injuries

Written and narrated by:Jody Moesch Ebeling, BSN, RN

Northeast Region Public Health Nursing Consultantand

Deborah L. Pasha, BSN, RNSoutheast Region Public Health Nursing Consultant

Wisconsin Division of Public Health

Learning ObjectivesAfter completing the module, public health nurses

should be able to:• Describe the role of the public health nurse in

the prevention of chronic diseases and injuriesp j• Recognize features of the community health

improvement plan as nursing process applied to the community-as-client

• Identify resources available to support disease and injury prevention

Overview of Module

• Definitions, statutory references, and theoretical models describing PHN role

• Conceptual framework of the community-as clientas-client

• Resources, including credible references and funding

• Application examples


Section I

Definitions, statutory references, and theoretical models describing

PHN role

State Administrative Rule Requirements (HFS 140.04)

All local health departments shall assume leadershipfor developing and maintaining the public health system for their area of jurisdiction and shall provide or arrange for the provision of at least the followingor arrange for the provision of at least the following services:Provide a generalized public health nursing program Prevent and control communicable diseasePrevent other diseasesPromote healthAbate and remove human health hazards

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What is Other Disease Prevention?

Examples of other diseases

• Arthritis• Asthma• Cancer• Cardiovascular illnesses• Cardiovascular illnesses• Diabetes• Mental illnesses• Substance abuse and addictions• Violence-related injuries

Prevention Terms and Definitions• Chronic disease• Injury, including unintentional and intentional• Community Health Improvement Plan• Epidemiology• Risk assessmentRisk assessment

Source: Wisconsin Statutes Chapter 255.01(1),Wisconsin Administrative Rule HFS 140.03

http://www.legis.state.wi.us/rsb/statutes.htmlhttp://www.legis.state.wi.us/rsb/code/codtoc.html

Statutory Requirements for Services to Prevent Other Diseases#1 Inform the public about the occurrence and

underlying causes of priority problems and emerging conditions, illnesses, injuries, and events affecting the health of the population.

#2 Disseminate prevention guidance related to#2 Disseminate prevention guidance related to diseases and injuries. Implement programs and environmental changes for population groups.

#3 Arrange screening, referral, and follow-up intervention services for population groups.

#4 Implement measures or programs to prevent or delay the onset of chronic disease and injuries.

Required Services # 1

Inform the Public

Public Health Intervention Wheel

http://dhfs.wisconsin.gov/phnc/InterventionWheel/index.htm

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C llab rati n

Public Health Nursing Role for Service #1

Disease & Health Event Investigation

Collaboration

Epidemiology Overview

www.cdc.gov/bam

Required Services #2

Disseminate prevention guidance

Implement programs and environmental changes

Community Or nizin


OutreachOrganizing


Arrange screening, referral, and follow-up

Outreach

Screening

Case Management

R f l &


Screening

Case Finding

Delegated Functions

Referral & Follow-up

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Implement measures known to prevent or delay the onset of chronic disease and injuries

Advocacy

Policy Coalition Building


Social Marketing

yDevelopment & Enforcement

g

Public Health Nurse OrientationServices to Prevent Other Diseases

Section II

Conceptual framework of the community-as-client

Community as Client

“The client or unit of care is the population.

While the public health nurse may engage in activities with individuals, families, or groups, d dua s, a es, o g oups,the dominant responsibility is the population as a whole.”

Source: Public Health Nursing: Scope & Standards of Practice

(ANA, 2007)

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Go in Search of your people. Love them. Learn from them. Play with them. Serve them. Begin with what they have. Build on what they know.y

But of the best leader, when the task is accomplished, the work is done, the people will remark “We have done it ourselves.”

- Old Chinese Proverb

Social Environment Physical Environment Genetic Endowment

IndividualResponse

• Social• Psychosocial

• Chemical• Physical• Biological• Built Environment

Health &Function Disease

Health Care

Well Being Prosperity

Adapted from Evans, R. G., & Stoddart, G. L. (1990). Producing health, consuming health care. Social Science and Medicine, 31, 1347-1363.

• Behavior• Biology

“The public health system seeks to extend the benefits of current knowledge in ways that will have maximum impact on the health status of the entire population. It is a collective effort to identify and address the unacceptable realities that result in preventable and avoidable health outcomes.”

(Turnock, 2001)

A System of Partners

Healthcare Consumers Community Health

Healthcare Providers

Faith Community

Professional Organizations

Advocacy Organizations

Media

Business& Labor

State & Local PublicHealth Departments

Educators

Colleges, Universities,& Technical Schools

Managed Care

Hospitals & Clinics

Healthcare Purchasers

Community Health CentersCivic

Organizations

Foundations

CommunityResidents

Law Enforcement

State andLocal Elected

Officials

Agriculture,Natural Resources, Public Instruction,

and other governmental

agencies

Public health nurses are a flexible entity

in an otherwise concrete enterprise.

(Marla E. Salmon, ScD, RN)

Visiting Nurse Service of New York

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A local board of health shall assure that measures are taken to provide an environment in which individuals can be healthy. 251.04 (7)y ( )

http://www.legis.state.wi.us/rsb/statutes.html

Community Health Improvement Plan (CHIP)

http://dhfs.wisconsin.gov/statehealthplan/practices/obj/chip.htm

Healthiest Wisconsin 2010: A Partnership Plan to Improve the

Health of the Public

http://dhfs.wisconsin.gov/statehealthplan/


Section III

Resources, including credible references and funding

Partners as Resource

• Manpower• Goals• Funds• Marketing• Policy development

Department of Health and Family ServicesDivision of Public Health

Bureau of Community Health Promotionhttp://dhfsweb/DPH/bchp.htm

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Funding to prevent disease and injuries

• Lead • MCH • Prevention• Prevention • Tobacco • WWWP

Grants and Contracts (GAC)https://apps4.dhfs.state.wi.us/ICSLogin/?"https://apps4.dhfs.state.wi.us/GACSystem/

http://www.cdc.gov/nccdphp/

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Section IV

Application examples

Practical Applications

Levels of Prevention

Primary Secondary Tertiary

Health Promotion

Disease Prevention

Early Diagnosis and

Disability Limitation

Rehab-ilitation

and Prompt Treatment

(Leavell & Clark, 1953)

Tobacco Prevention

A public health nurse partners with the local tobacco prevention coordinator to present the health effects of tobacco at the local chamber of commerce meeting. Following the presentation, member agencies have requested assistance to develop smoke-free work policies and implement tobacco cessation benefits for the employees.

Diabetes PreventionThe Regional Public Health Nurse Consultant informs local health departments that new evidence based diabetes care guidelines have been released. A workshop has been scheduled for local healthA workshop has been scheduled for local health department nurses to assist in implementation of guidelines with community partners. A local PHN sees the opportunity for partnership with other care providers in promoting optimum diabetes treatment to prevent or delay complications.

Diabetes Prevention Community Level Interventions

Educate the community leaders by holding a community educational sessionPartner with other providers to hold a community town hall meetingy gMedia advocacyMeet with community groups to promote good health Assist diabetes educators to implement care guidelines

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What level of public health intervention would address the determinants for all of these other diseases?

• Asthma• Cancer• Cardiovascular illnesses• Diabetes• Mental illnesses• Substance abuse• Violence-related injuries

Success Story: Issue

Success Story: Intervention Success Story: Impact

More steps• Pledge drive encouraging residents to commit

replacing one trip per week with active transportation

• Issue paper informing an asthma coalition’s stakeholders regarding the impact of alternative g g ptransportation on air quality and emergency department visits for asthma

• Letter to a bicycle pedestrian advocacy organization linking the health priorities to the need for bike racks on buses (cited at a public hearing, resulting in a unanimous vote of approval!)

IImpact and Value:

Telling Your Program’s Story

Success stories can be used:

In response to public inquiries about the program.To educate decision makers.To demonstrate that funds are well spent.To make the target population aware of your program.To show movement in program progress when planned outcomes will not be realized until the distant future.To help mobilize resources.To help your program get needed resources.

http://www.cdc.gov/oralhealth/publications/library/pdf/success_story_workbook.pdf

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Acknowledgments

This program was developed through a partnership between the Wisconsin Department of Health Services and the University of Wisconsin-Madison School of Nursing through the “Linking Education and Practice for Excellence in Public Health Nursing Project” funded by DHHS/HRSA/#D11HP07731.

This module would not have been possible without the input of the many public health nurses in academia and practice across the State of Wisconsin who contributed to this program. We would like to give special thanks to the those who provided content review of this module.

Acknowledgments (cont’d)Expert Consultation was provided by:• Linda Hale, BSN, RN, Chief Family Health Section• Cynthia A. Musial, CHES, Training and Technical Assistance

Coordinator, Tobacco Prevention & Control Program• Ann Altman Stueck, MSN, RN, Infant and Child Health Nurse

ConsultantWisconsin Division of Public Health Bureau of Community of

Health Promotion• Jeanne B. Hewitt, PhD, RNAssociate Professor, UWM College of Nursing Associate

Director, UWM Institute of Environmental Health Director, Community Outreach and Education Programs, National Institute of Environmental Health Sciences Marine & Freshwater Biomedical Sciences Center at UW-Milwaukee

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