UNIT I
Basis for Public Health Nursing
Knowledge and Skills
Chapter 1
Public Health and Nursing Practice
Christine Savage, Joan Kub, and Sara Groves
LEARNING OU TC OME S
After reading the chapter, the student will be able to:
1. Identify how public health plays a central role in the 4. Explore the connection between environment, resource
practice of nursing across settings and specialties. availability, and health.
2. Describe public health in terms of current frameworks, 5. Identify the key roles and responsibilities of public health
community partnerships, and the concept of population nurses (PHNs).
health. 6. Identify the formal organization of public health services
3. Investigate determinants of health within the context of from a global to local level.
culture.
K EY TER MS
Aggregate Determinants of Life expectancy Public health
Assessment health Low-income countries Public health nursing
Assurance Diversity (LICs) Public health science
Community Ethnicity Lower middle-income Race
Core functions Global health countries (LMICs) Upper middle-income
Cultural competency Globalization Policy development countries (UMICs)
Copyright © 2019. F. A. Davis Company. All rights reserved.
Cultural humility Health Population health
Cultural lenses High-income countries Population-focused
Culture (HICs) care
n Introduction quality of the public health infrastructure, and population-
level events such as disasters (natural and manmade), com-
Every day the media presents us with riveting stories: “The municable diseases (CDs), and violence. As nurses, we
flu season—the worst in a decade,” “Flint’s water supply provide care directly to individuals and families within
contaminated with high levels of lead,” “School shooting the context of the communities we serve. That context
leaves 17 dead,” “Hurricane Maria leaves 80% of Puerto encompasses diverse and unifying cultures, demographics,
Rico without power and water,” “Zika virus results in con- geography, infrastructure, resources, and the vulnerability
genital brain damage,” “The homicide rate in Chicago rises,” of certain members of the community. That is why under-
“More than 80 dead from the Camp Fire in California.” All standing health from a cellular to global level requires
of these stories reflect the connections among the health of a sound grounding in public health science, a central
individuals and families, the communities they live in, the component of nursing science and practice.
1
Savage, C. L. (2019). Public / community health and nursing practice : Caring for populations. F. A. Davis Company.
Created from senecac on 2023-01-27 01:51:33.
, 2 UNIT I n Basis for Public Health Nursing Knowledge and Skills
nursing. It is expected that upon graduation an entry-
n CELLULAR TO GLOBAL level nurse will be able to integrate knowledge from pub-
Health Across the Continuum lic health into their nursing practice. Nurses must apply
The health of individuals occurs across a continuum the nursing process and incorporate knowledge of the
from the cellular level to the global level. When we ecological and social determinants of health as they care
care for individuals and their families, understanding for individuals and families, and by extension commu-
the context of their health is vital to the promotion of nities and populations. Finally, they are expected to be
optimum health. For example, a person with type 2 dia- able to evaluate health within a global context and
betes who is seeking care may or may not have access demonstrate cultural humility in the care of individuals,
to the needed resources depending on what exists in families, communities, and populations.1 According to
their community as well as their own financial status. the American Nurses Association’s (ANA) Scope and
Providing care to that person requires use of pre- Standards, the importance of public health is clear.2
scribed medication, encouragement to exercise, and Other competencies grounded in public health include
encouragement to maintain a healthy diet. As you infection control (Chapter 8), emergency preparedness
learned in pathophysiology, type 2 diabetes occurs at and disaster management (Chapter 22), environmental
the cellular-level, but external factors may increase the health (Chapter 6), and a basic understanding of epi-
risk for being diagnosed with the disease. In addition, demiology (Chapter 3).
the community in which a person lives, both locally
and at the state level, has an impact on their ability to Public Health Science and Practice
pay for medications, to have access to safe areas for
exercise, and to obtain affordable fresh food. What exactly is public health science? Public health sci-
Likewise, individual health at the cellular level de- ence is the scientific foundation of public health practice
pends on the health of the Earth from a global level. and brings together other sciences including environ-
Optimal health requires access to basic resources mental science, epidemiology, biostatistics, biomedical
such as potable water, a secure food supply, sanitation, sciences, and the social and behavioral sciences.3,4
and adequate shelter. Events at the global level such Thus, public health science, as a combination of sev-
as climate change can result in the inability to obtain eral other sciences, allows us to tackle health problems
these needed resources. For example, following the using a wide range of knowledge. We apply the results of
2018 Camp Fire in California, which was associated public health science to deal with health problems on a
with climate change, many people lost their homes. regular basis. For example, the evidence that underlies
Outbreaks of communicable diseases (see Chapter 8) the reliability and validity of screening and diagnostic
in one part of the world can spread and affect many test results comes from the analysis of population-level
other parts of the world, such as the Zika virus data using the science of epidemiology. Public health sci-
outbreak in the summer of 2016. Natural disasters ence also provides the tools needed to try and solve a
often have far-reaching effects such as the tsunami problem in the community or in a geographical area.
Copyright © 2019. F. A. Davis Company. All rights reserved.
of 2004 that resulted in deaths and injury across When confronted with a health problem, health care
multiple countries including Indonesia, India, Malaysia, providers begin with the question “What can we do
Myanmar, Thailand, Sri Lanka, and the Maldives. Thus, about it?” This requires an examination of the underlying
all disease and injury occur within the context of the risks and protective factors related to the health problem,
health of the community and the globe. both individual and population based. Based on this type
of examination, lead experts in nursing used a population
health framework to develop a conceptual model of nurs-
As nurses, we apply public health science daily. Ob- ing that reflects the shift from a concentration on indi-
vious examples include infection control nurses, school vidual health alone to an understanding that health
nurses, and nurses in the public health department. occurs within the context of a population and factors that
Nurses working in an acute care setting also apply public support or undermine the health of the population as a
health science when using protective equipment and whole.5 Understanding the factors that contribute to
caring for a patient in isolation to prevent transmission health, both negative and positive, from both a popula-
of a CD. Public health science applies to every setting tion and an individual/family perspective allows us to de-
where nurses work; understanding public health and the velop nursing interventions that incorporate the full
science behind it is a core competency of professional continuum of health from individuals to populations,
Savage, C. L. (2019). Public / community health and nursing practice : Caring for populations. F. A. Davis Company.
Created from senecac on 2023-01-27 01:51:33.
, CHAPTER 1 n Public Health and Nursing Practice 3
and, it is hoped, to contribute with each intervention to focuses on the systematic collection, analysis, and mon-
the goal of the World Health Organization (WHO), the itoring of health problems and needs. Policy develop-
public health arm of the United Nations (UN): “… to ment refers to using scientific knowledge to develop
build a better, healthier future for people all over the comprehensive public health policies. Assurance relates
world.”6 to assuring constituents that public health agencies pro-
According to Issel,7 individuals do not achieve health vide services necessary to achieve agreed-upon goals.
through uninformed, individualistic actions. Instead, in- In 1994, the Public Health Functions Steering Com-
dividual health occurs within the surrounding context of mittee, a group of public and private partners, added fur-
the population and the environment. Therefore, all ther clarification to the definition by establishing a list of
nurses need skills and knowledge related to their pa- essential services (Chapter 13). The committee developed
tients’ informed actions within the context of the health the list of essential services through a consensus process
of their community. During the last century and into the with federal agencies and major national public health
21st century, public health science has been the backbone agencies (see Box 1-1). 9
of the nursing interventions we provide to individuals, Although the government is likely to play a leadership
families, and communities. Standard care, such as flu role in ensuring that essential services are provided, pub-
vaccinations, lead poisoning screening, and prevention lic, private, and voluntary organizations are also needed
programs, comes from work done using the principles to provide a healthy environment and are a part of
of public health science. As nurses, we must be suffi- the public health system. In a 2012 report by the IOM,
ciently competent to understand the basics of this science experts concluded that “… funding for governmental
and apply it daily in our care. After all, it is our heritage.
The modern founder of our profession, Florence
Nightingale, was an early pioneer in epidemiology and BOX 1–1 n Ten Essential Public Health Services
public health science.
Although public health has contributed significantly The 10 essential public health services provide the
to the health of the nation over the past century, it is framework for the National Public Health Performance
often difficult to define. In 1920, a respected public health Standards Program (NPHPSP). Because the strength
figure, C.E.A. Winslow, defined public health as: of a public health system rests on its capacity to effec-
tively deliver the 10 Essential Public Health Services,
… the science and art of preventing disease, prolonging life
the NPHPSP instruments for health systems assess how
and promoting health and efficiency through organized
well they perform the following:
community effort for the sanitation of the environment,
the control of communicable infections, the education of 1. Monitor health status to identify community health
the individual in personal hygiene, the organization of problems.
medical and nursing services for the early diagnosis and 2. Diagnose and investigate health problems and health
hazards in the community.
preventive treatment of disease, and for the development
3. Inform, educate, and empower people about health
of the social machinery to insure everyone a standard of
Copyright © 2019. F. A. Davis Company. All rights reserved.
issues.
living adequate for the maintenance of health, so organiz- 4. Mobilize community partnerships to identify and
ing these benefits as to enable every citizen to realize his solve health problems.
birth right of health and longevity.3 5. Develop policies and plans that support individual
and community health efforts.
Winslow’s definition reflects what public health is, the
6. Enforce laws and regulations that protect health and
scientific basis of public health, and what it does, and it ensure safety.
remains relevant to this day.4 7. Link people to needed personal health services and
In 1988, the Institute of Medicine (IOM), now known assure the provision of health care when otherwise
as the Health and Medicine Division (HMD) of the unavailable.
National Academies of Sciences, Engineering, and Med- 8. Assure a competent public health and personal
icine, in its report The Future of Public Health, added health-care workforce.
clarity to the term by defining public health as what so- 9. Evaluate effectiveness, accessibility, and quality of
ciety does collectively to assure the conditions for people personal and population-based health services.
to be healthy.8 It identified three core functions that en- 10. Research for new insights and innovative solutions to
compass the purpose of public health: (1) assessment, health problems.
(2) policy development, and (3) assurance. Assessment Source: (9)
Savage, C. L. (2019). Public / community health and nursing practice : Caring for populations. F. A. Davis Company.
Created from senecac on 2023-01-27 01:51:33.
, 4 UNIT I n Basis for Public Health Nursing Knowledge and Skills
public health is inadequate, unstable, and unsustain- Katrina, which savaged the Gulf Coast of the United
able.”10 Thus the promotion of population level health States in the summer of 2005. A horrified TV audience
requires a comprehensive public health infrastructure. watched news stories detailing the collapse of the emer-
According to Healthy People 2020 (HP 2020) the three gency systems in New Orleans. This collapse left people
essential infrastructure components include a capable to suffer and die, not only from the destruction of the
and qualified workforce, up-to-date data and informa- hurricane, but also from a lack of water, food, sanitation,
tion systems, and public health agencies capable of and medical attention. The aftermath of Katrina and
assessing and responding to public health needs (see the attacks of September 11, 2001, highlighted the need
Box 1-2). 11 to strengthen the public health infrastructure, with an
increasing emphasis on disaster preparedness and emer-
Public Health Frameworks: Challenges gency response. Unfortunately, responses to natural
disasters continue to challenge the United States as
and Trends exemplified by Hurricane Maria and the devastation
to Puerto Rico, and Hurricane Harvey in Houston,
Public health in the 21st century is facing new challenges
Texas, both in 2017. Full restoration of power and access
and trends that are likely to demand different frameworks
to food and potable water remained a challenge in
for its practice. Over the past 2 decades, numerous events
Puerto Rico long after the hurricane was over. Individ-
both here in the U.S, and globally have brought this fact
ual health requires essential services at the population
to the forefront including the attacks of September 11,
level including adequate sanitation, potable water, and
2001; numerous hurricanes; mass shootings; emerging
power. Understanding the interaction among cultural
CDs such as Ebola and the Zika virus; and massive
considerations, the economy of a country, and public
migrations of populations due to war. These events have
health infrastructure is essential to promotion of health
brought recognition to alarming public health concerns
and adequate response to disasters and subsequent
related to both manmade and natural disasters. These
threats to health.
events result in disease, death, displacement of commu-
Any disaster can quickly escalate from direct injuries
nities, and serious damage to essential public health
and deaths to indirect illness and risk of mortality be-
infrastructures.
cause of the destruction of the public health infrastruc-
To better understand the impact of both natural and
ture and the lack of public health resources especially for
manmade disasters, it is helpful to revisit Hurricane
vulnerable populations. CD outbreaks challenge com-
munities to respond in a way that provides care for those
with the disease as well as protection for those who are
BOX 1–2 n Healthy People 2020: Public Health in danger of getting the disease. Care for those with long
Infrastructure term noncommunicable disease (NCD) requires access
to care and to environments that support healthy living.
Public health infrastructure is fundamental to the provi- Across the continuum from cellular to global, public
Copyright © 2019. F. A. Davis Company. All rights reserved.
sion and execution of public health services at all levels. health systems are a key component in the promotion of
A strong infrastructure provides the capacity to prepare health and adequate care for those with disease. How-
for and respond to both acute (emergency) and chronic ever, much of the emerging threats to population health
(ongoing) threats to the nation’s health. Infrastructure is
are tied to increasing globalization.
the foundation for planning, delivering, and evaluating
public health. Public health infrastructure includes three Globalization is “the process of increasing economic,
key components that enable a public health organization political, and social independence and integration as cap-
at the federal, tribal, state, or local level to deliver public ital, goods, persons, concepts, images, ideas, and values
health services. These components are: cross state boundaries.”12 It is associated with increased
travel, trade, economic growth, and diffusion of technol-
A capable and qualified workforce
ogy, resulting sometimes in greater disparities between
Up-to-date data and information systems
Public health agencies capable of assessing and respond- rich and poor, environmental degradation, and food
ing to public health needs security issues. It has also resulted in greater distribution
of products such as tobacco or alcohol. With globaliza-
These components are necessary to fulfill the previ- tion, there is also an emergence and re-emergence of
ously discussed 10 Essential Public Health Services. CDs, including Zika, human immunodeficiency virus
Source: (11) (HIV), acquired immunodeficiency syndrome (AIDS),
Savage, C. L. (2019). Public / community health and nursing practice : Caring for populations. F. A. Davis Company.
Created from senecac on 2023-01-27 01:51:33.
