Running head: NURSING'S ROLE IN POPULATION BASED ISSUES

Nursing's Role in Population Based Issues ElizaBeth McManus Ferris State University

NURSING'S ROLE IN POPULATION BASED ISSUES Abstract

Lack of prenatal care for adolescent expecting women remains a large problem in Kent County. Nursing professionals in many roles and settings can play a vital role in reducing the rate of low birth weight and high mortality rate. Direct contact with the adolescent population is needed to implement and assess need for prenatal care as well as population based leadership involvement at a policy level to encourage change in Kent County for our community change project to be successful.

NURSING'S ROLE IN POPULATION BASED ISSUES Nursings Leadership Role in Population Based Three core functions stated in an article in the Washington state nurses association are: assessment, policy development and assurance. Assessment can be done by the direct contact

nurse where she may also have additional roles such as collecting data on the health status of the population at an individual level, health screening activities, communicable disease and illness surveillance, and data analysis. The direct care nurse needed in advocating for prenatal care could associate with the health department mainly engaging in direct personal health services to individuals and families from vulnerable and at risk communities- home visits for high risk pregnant women such as teens (WSNA, 2011). A leadership role will take on activities such as policy development and assurance. The assurance role ensures compliance with public health standards and regulations, the health needs and interests of the public are met and that quality health services are accessible (WSNA, 2011). Protecting the health of the population the Case finder identifies occurrences of specific diseases or condition, in this case lack of prenatal care among adolescent expecting women (Harkness & DeMarco, 2012).

Direct Care Health Department Nurse Public health nurses provide care in many settings mainly associated with the health department, including community health clinics, churches, homeless shelters, schools, within the home of the patient, at health fairs and at agencies and institutions (AJN, 2009). Leadership Role Public health nurses serve as leaders in public health organizations such as the health department as stated above, the role of the direct nurse will include promoting healthy living, and implementing care for the population and individual with the use of maternal home visit, or at

NURSING'S ROLE IN POPULATION BASED ISSUES the population level programs like WIC (WSNA, 2011). The WIC program is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (AJN, 2009). The characteristics needed to be effective in carrying out the direct nurse leadership role would include critical thinking, advocacy and analytical abilities. Characteristics for any Public Health Nursing (PHN) include adaptability and willingness to provide care in many settings and environments, broad understanding of health issues and the ability to find comfort with autonomy, change and uncertainty (AJN, 2009).

ANA Standards of Professional Practice American Nursing Association (ANA) Scope and Standards of Practice states that the activities and accountabilities that are characteristic of practice at all levels and settings- this including all the settings stated above where a PHN will provide care. Public health nursing is distinguished from other specialties by the devotion to eight principles called the eight domains of public health nursing practice this establishes the characteristics of competent public health nursing practice and is the legal standard of practice. Most of the characters listed above are include in the eight domains, some additional are communication skills cultural competency skills, financial planning and management skills (Harkness & DeMarco, 2012). Leader/Manager Role Possible agencies for a nurse in an assurance nurse leader such as a case finder would include Public Health Accreditation Board where the assurance for accountable public health practice, the delivery of high quality and safe public health services, and improving the efficiency and effectiveness of the public health delivery system are in alignment with national priorities (WSNA, 2011). Washington State Nurses Association is also an agency as I observe

NURSING'S ROLE IN POPULATION BASED ISSUES the acknowledgements of this article utilizing nurses in the leadership role in assuring compliance as it is a neglected and eroding infrastructure, effecting the health prevention and health promotion priorities at a local and national level (WSNA, 2011). Leadership Role A nurse in a leadership role can be a contributor to the Department of Health, taking on the task of goal setting this including focus on prevention and early detection which is the core interest of prenatal care. (WSNA, 2011) Public health nurses serve as leaders in public health organizations, the role of assurance will evaluate population level prevention programs such as

the WIC program (AJN, 2009) (WSNA, 2011).The case finder in our prevention project will use epidemiologic investigation techniques, watch for signs that the number of cases is above the mean, participate in planning control and prevention measures, evaluate results, report findings, and provide follow up service (Harkness & DeMarco, 2012). Nurse leaders in public health have asserted their expertise in prevention and health promotion and their experience in delivering care on the policy circles. More than half of state public health departments have a senior nurse executive, while some of these individuals as in our case of the case finder hold positions of limited scope and authority, their valued assets have positioned them to play major roles in developing effective policies for assuring public health (Fauteux). Stated in the Washington State Nurses Association article and the Public Health Quality Forum- (Healthy people 2020, 2009), quality public health as population centered, equitable, proactive, health promoting, riskreducing, vigilant, transparent, effective, and efficient. These may be viewed as qualities for public health, as well as needed characteristics to effectively carry out this nurse leadership role (WSNA, 2011). The characteristics needed to be effective in carrying out the population based

NURSING'S ROLE IN POPULATION BASED ISSUES leadership role would include critical thinking, advocacy, analytical abilities, and have a broad understanding of health issues (AJN, 2009). ANA Standards of Professional Practice American Nursing Association (ANA) Scope and Standards of Practice states that the activities and accountabilities that are characteristic of practice at all levels and settings. Public health nursing is distinguished from other specialties by the devotion to eight principles called the eight domains of public health nursing practice, this establishes the characteristics of

competent public health nursing practice and is the legal standard of practice. As similar as listed above in the characteristics of a public health leader position, the eight domains include analytic assessment skills, policy development and program planning skills, leadership and systems thinking skills (Harkness & DeMarco, 2012). Analysis The roles of the direct care nurse are similar to the population based nurse leader in many ways, including critical thinking, advocacy, analytical abilities, and having a broad understanding of health issues. Also, the eight domains all apply to both, some more for one than the other. They both can work for the same agency, that being the health department at the local, state, or national level. The domains as similar as they are also pose the question of how both of these positions utilize the characteristics. The direct care nurse will use her communication and cultural skills on a more individual level, while the leadership role will use these skills at a population or professional base level. The different positions will have different expectations to the health department, besides the other options for agencies being different for each position. Prenatal care for adolescence need to be assessed at the individual direct care level, impacting each pregnant adolescent by educating them on the importance of utilizing prenatal care,

NURSING'S ROLE IN POPULATION BASED ISSUES administering home care visits, comforting them in whatever setting needed. The impact of the case finder would start with investigating need by watching for signs, then lead into evaluating results and finally reporting the findings to the senior nurse executive, who would use them in taking part in their states health policy debate in the hopes for a needed change such as more funding for prenatal education for adolescence. One of the implications of direct care nursing skills as different from the population base nurse is the ability to adapt to multiple settings

impacting the lives of adolescent pregnant women who otherwise would not obtain prenatal care. The implication of the skills the nurse leader provides is that of essentially being the middle man between the direct care nurse and the executive. This I feel is a very important position for prenatal care improvement for adolescence- investigating the need and presenting it for the use of making a change. Reflection I enjoy working at an individual level as I do now, but Im not sure that I would succeed in having the ability to adjust to the continually changing setting requirements of a direct PHN. As for finding the competence in the role of the direct PHN leader, I may need to find a role at the health department and not have the obligation to administer home visits. I like to analyze and evaluate information, but I would be challenged by the investigation role of the case finder position. After achieving my BSN I will have had adequate practice in improving on the investigation or research role in turn improving my competency.

NURSING'S ROLE IN POPULATION BASED ISSUES References Fauteux, N. (2008, September). Strengthening Public Health NursingPart II; How Nurse Leaders in Policymaking Positions Are Transforming Public Health. Pittsburgh, PA: Spann Communications, LLC.

Harkness, G. A., & DeMarco, R. F. (2012). Community and Public Health Nursing: Evidence for Practice. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Meadows, P., (2009). Community health nursing. AJN, American Journal of Nursing, 109:19. Retrieved October 7, 2013 from http://journals.lww.com/ajnonline/fulltext/2009/01001/community_health_nursing.5.aspx U.S. DHHS. (2009b).Healthy People 2020. Retrieved October 1, 2013 from http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=44&TopicArea=S ocial+Determinants+of+Health Washington State Nurses Association (WSNA). 2011 Public health and public health nursing. Retrieved October 5, 2013 from http://www.wsna.org/practice/publications/documents/Position%20Paper%20on%20Publ ic%20Health%20r2.pdf