Discussion Question

Analyze the roots of public health nursing. Explain its influence on practice today.
APA style
3 paragraphs 3 sentences each
2 references

Chapter 3: Health Policy, Politics, and Reform

Chapter Highlights #1
Healthcare policy and the political process
Healthcare finance and cost–benefit in relation to health policy
Access to healthcare and insurance facts in the United States
Healthcare workforce diversity and its effects on the quality of healthcare
Nursing’s role in shaping healthcare policy

Chapter Highlights #2
Quality of care and evaluation
Information management facts
Equity in healthcare access
Ethical consideration in health policy
Political advocacy, how to be politically active and advocate

Chapter Highlights #3
Health advocacy and healthcare reform
Affordable Care Act (ACA) overview and updates
Community-based services and healthcare reform
Health services research application to healthcare policy

Healthcare Policy and Political Process
Policies: set of principles that govern an action to achieve a given outcome, or guidelines that direct individuals’ behavior toward a specific goal
Public health policy: decisions made in regard to the health of the individual and the community
Health policies: impact on the health of an individual, a family, and a population or community

Question #1
Is the following statement true or false?
Health policies impact on the health of an individual, a family, and a population or community.

Answer to Question #1
True
Rationale: Health policies impact on the health of an individual, a family, and a population or community.

Involving Politics
Process of influencing the allocation of resources needed to enable policy and involves the strategies needed to achieve the desired goals.
Policy-making takes a great deal of effort, time, and commitment.
Setting an agenda
Policy formulation
Policy adoption
Policy implementation
Policy assessment
Policy modification

Healthcare Finances and Cost-Benefit
Economics is the study of how individuals, groups, organizations, and society allocate and utilize resources.
When a policy is evaluated for its effectiveness, there is an interest in keeping the cost of a specific health program within reason, and it is critical to consider the overall costs and benefits of an existing program when a more efficient and effective service is identified and adopted.

Access to Care and Health Insurance
The U.S. healthcare system is a unique system of both independent and collaborative power and action by both federal and state governments.

Question #2
Is the following statement true or false?
The U.S. healthcare system is a unique system of both independent power and action by the federal government.

Answer to Question #2
False
Rationale: The U.S. healthcare system is a unique system of both independent and collaborative power and action by both federal and state governments.

Nursing’s Role in Shaping Healthcare Policy
Nursing has a rich history as a unique profession, with its own values, ethics, respect, integrity, and responsibility. Nurses’ contributions to the policies are unlimited; there is a need for greater coordination of action to ensure that nursing is actively supported and involved in influencing and shaping health and healthcare policies.

Historical Highlights on Nursing Political Involvement
Mid-‘70s and early ‘80s: Political involvement of nurses
1976: Important year of advocacy
1990s: Nurses included in healthcare policy formation

What Does It Mean to Be Politically Active?
Personal and professional political involvement of nurses
Nurses must be knowledgeable about issues, laws, and policy
Why is nurse-informed political involvement?
Direct caregivers
Awareness of patient safety and satisfaction, access to services, clinical outcomes, and health disparities
Positioned to see impact of policy on individuals

Nursing Advocacy and Policy Participation
Patient advocacy
Political advocacy

How to Be Politically Involved?
Evidence-based practice examples
Nurses’ milestones in policy development have contributed to:
Quality outcomes
Decreases in cost
Expanded access
Major differences to the health of the nation

Advocacy Activities of Professional Nursing Organizations
Role of professional nursing organizations
ANA
NLN
ICN

Current Situation of Nursing Involvement: Challenges and Barriers
Not enough time to get involved
Heavy workloads with understaffing
Perception of powerlessness
Gender issues
Political action breaching family time
Anxiety with public speaking
Lack of knowledge in legislative process
Fear of retaliation

Quality of Care
Safety
Effectiveness
Patient centeredness
Timeliness
Equality
Quality of care is defined by the Institute of Medicine (2001) as the degree to which health services for individuals and populations increase the likelihood of desired outcomes, and are consistent with current knowledge.
It is extremely difficult to evaluate the complexities of the quality of care for the U.S. population.

Information Management
U.S. policy-makers have made the adoption of health information technology a priority so that health records can be kept electronically, assisting patients, providers, and insurers.

Equity and Equality in Healthcare Access and Quality
Because of the vast disparities in healthcare access and quality, President Obama has made healthcare his top priority, promising affordable and adequate healthcare insurance for all Americans.

Question #3
Is the following statement true or false?
Equality is healthcare that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status.

Answer to Question #3
True
Rationale: Equality is healthcare that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status.

Community-Based Services Association with Healthcare Reform
Federally qualified health centers
Patient-centered medical home
Accountable care organizations
Meaningful use

Ethical Considerations
ANA Code of Ethics with Interpretive Statements
Code of Ethics for Nurses
Social Policy Statement
Scope and Standards of Practice in Nursing

Health Advocacy and Healthcare Reform
Advocacy is collaborating with colleagues and engaging in conversations with decision-makers
Healthcare systems are dynamic

Overview of the ACA Prior to the End of Obama Presidency
Patient Protection and Affordable Care Act
Health Care and Education Reconciliation Act

Health Services Research
Research continues to be an influencing power by documenting the need for accelerated reform in order to achieve quality care, proper information management, insurance for all, and equity of access.

Chapter 1: Public Health Nursing: Present, Past, and Future

Chapter Highlights
Healthcare changes in the 21st century
Characteristics of public health nursing
Public health nursing roots
Challenges for practice in the 21st century

Question #1
Is the following statement true or false?
Healthcare disparities are social conditions in which people live and work.

Answer to Question #1
False
Rationale: Social determinants of health are social conditions in which people live and work. Healthcare disparities are gaps in healthcare experienced by one population compared with another.

Major Changes in Healthcare in the 21st Century
Development of patient/client-centered care
Increased use of technology
Increased personal responsibility

Healthcare Changes in the 21st Century #1
Social determinants of health are social conditions in which people live, their income, their social status, their education, their literacy level, their home and work environment, their support networks, their gender, their culture, and the availability of health services

Healthcare Changes in the 21st Century #2
Healthcare disparities—differences in healthcare and health outcomes experienced by one population compared with another

Role of Government in Healthcare
Three core functions are as follows:
Assesses healthcare problems
Intervenes by developing relevant healthcare policy that provides access to services
Ensures that services are delivered and outcomes are achieved

Patient Protection and Affordable Care Act (PPACA)
Provide affordable health insurance coverage to most Americans
Lower costs
Improve access to primary care
Preventive care and prescription benefits
Cover pre-existing conditions
Extend young adults’ coverage

Question #2
What is one of the core functions of the role of government in healthcare?
Provide affordable health insurance coverage
Improve access to primary care
Lower costs
Assess healthcare problems

Answer to Question #2
D. Assess healthcare problems
Rationale: Three core functions are to assess healthcare problems, intervene by developing relevant healthcare policy that provides access to services, and ensure that services are delivered and outcomes are achieved. One of the goals of the Patient Protection and Affordable Care Act (PPACA) is to provide affordable health insurance coverage.

Patient/Client-Centered Care
Cultural traditions
Personal preferences
Values
Families
Lifestyles

Technology
Rapidly advancing forms of technology are dramatically improving lives.

Health Information Technology
Health information technology (HIT)—comprehensive management of health information and its exchange between consumers, providers, government, and insurers in a secure manner
Electronic health records

Telehealth
Use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration

Personal Responsibility for Health
Active participation in one’s own health through education and lifestyle changes

Public Health Nursing
Public health nursing—population-based practice, defined as a synthesis of nursing and public health within the context of preventing disease and disability and promoting and protecting the health of the entire community

Principles of Public Health Nursing #1
Client or unit of care is the population.
Primary obligation is to achieve the greatest good for the greatest number of people or people as a whole.
Public health nurses collaborate with the client as an equal partner.

Principles of Public Health Nursing #2
Primary prevention is the priority in selecting appropriate activities.
Public health nursing focuses on strategies that create healthy environmental, social, and economic conditions in which populations may thrive.

Principles of Public Health Nursing #3
A public health nurse is obligated to actively identify and reach out to all who might benefit from a specific activity or service.
Optimal use of available resources and creation of new evidence-based strategies is necessary to assure the best overall improvement in the health of populations.

Principles of Public Health Nursing #4
Collaboration with other professions, populations, organizations, and stakeholder groups is the most effective way to promote and protect the health of people.

Scope and Standards of Practice
The American Nurses Association sets the scope and standards for all professional nursing practice.
The publication Public Health Nursing: Scope and Standards of Practice establishes the characteristics of competent public health nursing practice and is the legal standard of practice.

Competencies for Public Health Nursing Practice
Three tiers of practice
Competencies associated with that level of practice

Public Health Intervention Wheel
17 interventions
Actions taken on behalf of individuals, families, communities, and systems to protect or improve health status

Public Health Nursing Interventions
Population-based model
Applied to individuals, families, communities, or within systems
Focuses upon prevention

Education for Public Health Nursing Practice
Public health nursing practice
Baccalaureate degree in nursing (BS or BSN)
Generalist master’s degree as clinical nurse leader (CNL)
Public health nursing specialists in population health
MSN
MPH
MSN/MPH
Doctoral degrees: PhD, DNP, DrPH

Roots of Public Health Nursing
Early civilization
Middle Ages
English Poor Law
Variety of reforms in 1800s
Victorian times
District nursing

Public Health Initiatives in Early America
American social values strongly influenced by British traditions
Need for organized public health system
Lemuel Shattuck
Dorothea Dix
Clara Barton
Lillian Wald

Public Health Initiatives in the 20th Century
Mary Breckinridge
Early 20th-century federal healthcare initiatives
Public health in the second half of the century

The First Decade of the 21st Century
Department of Homeland Security: fosters an all-hazards, all-disciplines approach to emergency management
Must be flexible, be politically active, embrace change, and refresh their knowledge of public health issues on a continual basis

Engaging in Evidence-Based Practice
Evidence-based nursing is the integration of the best evidence available with clinical expertise and the values of the client to increase the quality of care.

Evidence-Based Public Health
Public health endeavor with judicious use of evidence derived from a broad variety of science and social science research

Epidemiology
Science of prevention
Knowledge of the natural history of diseases and the identified (risk) factors that increase a person’s susceptibility to illness

Challenges for Public Health Nursing in the 21st Century #1
Engaging in evidence-based practice
Helping eliminate health disparities in underserved populations
Demonstrating cultural competence
Planning for community change
Contributing to a safe and healthy environment

Challenges for Public Health Nursing in the 21st Century #2
Responding to emergencies, disasters, and terrorism
Responding to the global environment

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