Public Health Interventions Applications for Public Health Nursing Practice

Public Health Interventions Applications for Public Health Nursing Practice March 2001 Minnesota Department of Health Division of Community Health Services Public Health Nursing Section Public Health Interventions Applications for Public Health Nursing Practice March 2001 Public Health Nursing Practice for the 21st Century Project Director: Mary Rippke, RN, MA Project Coordinator: Laurel Briske, RN, MA, CPNP Project Staff: Linda Olson Keller, RN, MS, CS, and Sue Strohschein, RN, MS Administrative Assistant: Jill Simonetti Development of this document was supported by federal grant 6 D10 HP 30392, Division of Nursing, Bureau of Health Professions, Health Resources and Service Administration, United States Department of Health and Human Services. Minnesota Department of Health Division of Community Health Services Public Health Nursing Section Acknowledgments Public Health Interventions: Applications for Public Health Nursing Practice acknowledges the tremendous contribution made by practicing public health nurses (PHNs) and educators from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin. Special thanks go to the graduate students who identified and analyzed relevant intervention literature. Forty-six practice experts and educators from those same states volunteered to serve on review panels, devoting hours of their time and, more importantly, their practice wisdom. An additional 150 preceptors and participants from the Public Health Nursing Practice for the 21st Century project provided invaluable input for clarification and richness of the content. This document could not have happened without them. Gratitude also goes to LaVohn Josten and Sharon Cross, School of Nursing, University of Minnesota for their insight and evaluation expertise. The interventions also reflect the talents and skills of many Minnesota Department of Health staff. In particular we want to acknowledge our colleagues in the Section of Public Health Nursing, Marie Margitan, Terre St. Onge, and Karen Zilliox; Diane Jordan and the library services’ staff; and Lisa Patenaude, former administrative assistant. We are interested in learning more about how the model is being used or adapted. If you have comments or questions, please contact us. Linda Olson Keller 651/296-9176 [email protected] Sue Strohschein 320/650-1078 [email protected] Suggested citation: Public Health Nursing Section: Public Health Interventions–Applications for Public Health Nursing Practice. St. Paul: Minnesota Department of Health, 2001. Literature Search Managers Mary Jo Chippendale, University of Minnesota Jennifer Deschaine, Bethel College Kathy Lammers, Winona State University Deborah Meade, Augsburg College Jackie Meyer, University of Iowa Dolores Severtson, University of Wisconsin-Madison Victoria Von Sadovszky, University of Wisconsin-Madison Expert Panelists Iowa Elaine Boes, Palo Alto County Community Health Service Nancy Faber, Worth County Public Health Marti Franc, Des Moines Visiting Nurse Services Penny Leake, Winneshiek County Public Health Therese O’Brien, Lee County Health Department Janet Peterson, Iowa Department of Health Jane Schadle, Wellmark Community Health Improvement Lu Sheehy, Skill Medical Center Jenny Terrill, Iowa Department of Health Minnesota Mary Kay Haas, Minnesota Nurses Association Bonnie Brueshoff, Dakota County Public Health Terre St. Onge, Minnesota Department of Health Jean Rainbow, Minnesota Department of Health Karen Zilliox, Minnesota Department of Health Barb Mathees, Minnesota State University-Moorhead Cecilia Erickson, Minneapolis Public Schools Ane Rogers, Cass County Public Health Rose Jost, Bloomington Health Department Dorothea Tesch, Minnesota Department of Health Nancy Vandenberg, Minnesota Department of Health Ann Moorhous, Minnesota Department of Health Mary Sheehan, Minnesota Department of Health Penny Hatcher, Minnesota Department of Health North Dakota Ruth Bachmeier, Fargo Cass Public Health Nancy Mosbaek, Minot State University Cheryl Hagen, Fargo Cass Public Health Kelly Schmidt, First District Health Unit–Minot Debbie Swanson, Grand Forks Public Health Department Barb Andrist, Upper Missouri District Health Unit South Dakota Nancy Fahrenwald, South Dakota State University Darlene Bergeleen, South Dakota Department of Health Joan Frerichs, Grant County–Milbank Paula Gibson, South Dakota Department of Health Wisconsin Judy Aubey, Madison Department of Public Health Elizabeth Giese, Division of Public Health-Wisconsin Barbara Nelson, St. Croix Health & Human Services Department Tim Ringhand, Chippewa County Department of Public Health Marion Reali, Eau Claire City/County Health Department Gretchen Sampson, Polk County Health Department Vicki Moss, Viterbo College Joan Theurer, Wisconsin Department of Health & Family Services Julie Willems Van Dijk, Marathon County Health Department Public Health Nursing Interventions Public health nurses (PHNs) work in schools, homes, clinics, jails, shelters, out of mobile vans and dog sleds. They work with communities, the individuals and families that compose communities, and the systems that impact the health of those communities. Regardless of where PHNs work or whom they work with, all public health nurses use a core set of interventions to accomplish their goals. Interventions are actions that PHNs take on behalf of individuals, families, systems, and communities to improve or protect health status. This framework, known as the “intervention model,” defines the scope of public health nursing practice by type of intervention and level of practice (systems, community, individual/family), rather than by the more traditional “site” of service, that is, home visiting nurse, school nurse, occupational health nurse, clinic nurse, etc. The intervention model describes the scope of practice by what is similar across settings and describes the work of public health nursing at the community and systems practice levels as well as the conventional individual/family level. These interventions are not exclusive to public health nursing as they are also used by other public health disciplines. The public health intervention model does represent public health nursing as a specialty practice of nursing. (See The Cornerstones of Public Health Nursing, Appendix A) An enlarged black and white copy of the wheel can be found in Appendix B. Section of Public Health Nursing Public Health Minnesota Department of Health 1 Interventions The Intervention Wheel The model, or the “intervention wheel,” as it has come to be known, integrates three distinct and equally important components: 1. The population-basis of all public health interventions 2. The three levels of public health practice: Community Systems Individual/family 3. The 17 public health interventions: Surveillance Disease and Health Threat Investigation Outreach Screening Case-Finding Referral and Follow-up Case Management Delegated Functions Health Teaching Counseling Consultation Collaboration Coalition Building Community organizing Advocacy Social Marketing Policy Development and Enforcement The model itself consists of a darkened outside ring, three inner rings and seventeen “slices.” Each of the inner rings of the model are labeled “population-based,” indicating that all public health interventions are population- based. A population is a collection of individuals who have one or more personal or environmental characteristics in common.1 A population-of-interest is a population that is essentially healthy, but who could improve factors that promote or protect health. A population-at-risk is a population with a common identified risk factor or risk-exposure that poses a threat to health. 1. Public health interventions are population-based if they focus on entire populations possessing similar health concerns or characteristics. This means focusing on everyone actually or potentially impacted by the condition or who share a similar characteristic. Population-based interventions are not limited to only those who seek service or who are poor or otherwise vulnerable. Population-based planning always begins by identifying 1Williams, C. A., Highriter, M. E. (1978). Community health nursing–population and practice. Public Health Reviews, 7(4), 201. Section of Public Health Nursing Public Health Minnesota Department of Health 2 Interventions everyone who is in the population-of-interest or the population-at-risk. For example, it is a core public health function to assure that all children are immunized against vaccine-preventable disease. Even though limited resources may compel public health departments to target programs toward those children known to be at particular risk for being under or unimmunized, the public health system remains accountable for the immunization status of the total population of children. 2. Public health interventions are population-based if they are guided by an assessment of population health status that is determined through a community health assessment process. A population-based model of practice analyzes health status (risk factors, problems, protective factors, assets) within populations, establishes priorities, and plans, implements, and evaluates public health programs and strategies.2 The importance of community assessment cannot be emphasized enough. All public health programs are based on the needs of the community. As communities change, so do community needs. This is why the core function of assessment is so important.3 Public health agencies need to assess the health status

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