Disaster management in community health nursing

Disaster Managemnt And The Role Of The Community Health Nurse

Learning Materials

Clark, M. J. (2015). Population and community health nursing (6th ed.). Boston, MA: Pearson Chapter 25
http://www.redcross.org/get-help/prepare-for-emergencies/be-red-cross-ready

Assignment:

· Create a power point with the intended audience to be a community health department.

· Focus on a real or fictional disaster that has or could affect your area. For example, if you live on the Florida coast you might choose potential hurricane.

· Discuss the role of the Community Health Nurse in each stage of disaster. You should include a few slides on each stage of disaster: preparedness, response, recovery with specific activities and resources that the public health nurse would use in each stage.

· Identify other agencies that might be involved.

The assignment should be submitted in Power Point format, with at least 15 content slides (in addition to a title slide and reference slide) and include at least 3 scholarly sources(less than 5 years old) other than provided materials. Disaster Management and the Role of the Community Health Nurse

POPULATION AND COMMUNITY HEALTH

NURSING

Mary Jo Clark

Sixth Edition

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Library of Congress Cataloging-in-Publication Data Clark, Mary Jo Dummer, author. [Community health nursing] Population and Community Health Nursing / Mary Jo Clark. — Sixth edition. p. ; cm. Preceded by: Community health nursing / Mary Jo Clark. 5th edition. 2008. Includes bibliographical references and index. ISBN 978-0-13-385959-1 ISBN 0-13-385959-2 I. Title. [DNLM: 1. Community Health Nursing. 2. Nursing Process. WY 106] RT98 610.73’43—dc23 2014024175

ISBN-10: 0-13-385959-2 ISBN-13: 978-0-13-385959-1

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Mary Jo Clark, PhD, RN, PHN, has been practicing and teaching population health nursing for 50 years. After completing her BSN degree at the University of San Francisco, she received her in- troduction to global population health nursing as a U.S. Peace Corps Volunteer in Vita, India, a ru- ral town with a population of about 3,000. Returning to the United States, Dr. Clark employed her cross-cultural expertise as a Public Health Nurse in the Los Angeles County Department of Health Services. In 1973, she became a pediatric nurse practitioner, and later began teaching population health nursing at East Tennessee State University. She completed a master’s degree as a com- munity health clinical nurse specialist at Texas Women’s University and a PhD in nursing at the University of Texas at Austin. Moving with her army nurse husband to Augusta, Georgia, she taught graduate and undergraduate population health at the Medical College of Georgia. For the past 29 years, Dr. Clark has taught at baccalaureate, master’s, and doctoral levels at the University of San Diego, Hahn School of Nursing and Health Science. In addition to her full-time teaching and writing, Dr. Clark has maintained an active population health nursing practice. She is well known in the population health nursing field and has provided consultation and made presentations across the country and overseas. Her many and varied experiences in population health nursing in the United States and abroad form the core of the material presented in this book.

About the Author

This book is lovingly dedicated to Phil the elder, Phil the younger, and Heather, who are the wind beneath my wings, and to my fellow population health nurses and faculty across the country and around the globe. Little by little we are improving the health status of the world’s population.

Dedication

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Reviewers Our heartfelt thanks go to our colleagues from schools of nursing across the country and others who have given time generously to help create this exciting new edition of our text. These individuals helped us plan and shape our book and resources by reviewing chapters, art, design and more. Population and Community Health Nursing has reaped the benefit of your collective knowledge and experience as nurses and teachers, and we have improved the materials due to your efforts, suggestions, objections, endorsements and inspira- tion. Among those who gave their time to help us are the following:

Thank You!

Dr. Sue Bhati, PhD,FNP-BC,NP-C,MSN,RN Northern Virginia Community College Springfield, Virginia Terese Blakeslee, MSN, RN, Ed University of Wisconsin Oshkosh, Wisconsin Anne Watson Bongiorno, Ph.D., APHN-BC, CNE SUNY Plattsburgh Plattsburgh, New York Angeline Bushy, PhD, RN, FAAN, PHC University of Central Florida Daytona Beach, Florida Kim Clevenger, EdDc, MSN, RN, BC Morehead State University Morehead, Kentucky Angela Cox, RN, MS Ball State University—School of Nursing Muncie, Indiana Mary P. Curtis, RN, PhD, ANP-BC, PHCNS-BC Barnes-Jewish College, Goldfarb School of Nursing St. Louis, Missouri Pamela Davis, MSN, RN, ANP, CPHQ Northern Kentucky University Highland Heights, Kentucky Julia K. Donegan, MS, APHN-BC, RN The Ohio State University—College of Nursing Columbus, Ohio Charlene Douglas, PhD, MPH, RN George Mason University Fairfax, Georgia Janice Edelstein, RN, EdD University of Wisconsin Oshkosh, Wisconsin Susan England, PhD, RN Texas State University Round Rock, Texas Melissa Garno, EdD, RN Georgia Southern University—School of Nursing Statesboro, Georgia Camille Groom, RN,MS Miami-Dade College School of Nursing Miami, Florida

Tammy Haley, PhD, CRNP University of Pittsburgh at Bradford Bradford, Pennsylvania Linda James, MSc, RN Sam Houston State University Huntsville, Texas Nancy Jones, MSN, RN Kent State University Kent, Ohio Toshua Kennedy, MSN/MPH, BSN, ADN The University of South Carolina Upstate Greenville, South Carolina Nancy Laplante, PhD, RN Neumann University Aston, Pennsylvania Sherry Lovan, PhD, RN Western Kentucky University Bowling Green, Kentucky Paula McNiel, DNP, RN, APHN-BC University of Wisconsin Oshkosh—College of Nursing Oshkosh, Wisconsin Richard Ralls, RN, BSN Florida International University Miami, Florida Kate Shade, PhD, RN Samuel Merritt University Oakland, California Ashley Shroyer, MSN, RN, CNE Fairmont State University Fairmont, West Virginia Virginia Teel, DHSc, RN Georgia Southern University Statesboro, Georgia Anne Watson Bongiorno, Ph.D., APHN-BC, CNE SUNY Plattsburgh Plattsburgh, New York Kim White, PhD, MS, CNS-BC Southern Illinois University Edwardsville—School of Nursing Edwardsville, Illinois

Lisa Rae Dummer, Transgender Law Center San Francisco, California

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Preface

This book represents the lessons learned and the prog-ress made in more than 100 years of population health nursing in the United States. The year 1993 marked the 100th anniversary of the founding of the Henry Street Settlement, the acknowledged beginning of modern American population health nursing. Since then, the work of population health nurses and others has led to better health for individuals, families, and population groups. In this book, I have tried to dis- till the wisdom of early pioneers and present-day practitioners to guide and direct future generations toward nursing excellence.

Locally, nationally, and globally, society is in greater need of population health nursing services than at any time since our be- ginning. Although expected longevity has increased significantly in the last century, quality of life has not kept pace for a large por- tion of the world’s population. Previously controlled communi- cable diseases are resurfacing, and new diseases are emerging to threaten the public’s health. Malnutrition is a fact of life for many people. Chronic physical and emotional diseases are taking their toll on the lives of large numbers of people. Substance abuse and violence are rampant, and more and more frequently, environ- mental conditions do not support health. All of these are problems that population health nurses can and do help to solve.

Population health nurses must have the depth and breadth of knowledge that allows them to work independently and in conjunction with clients and others to improve the health of the world’s populations. In part, this improvement occurs through care provided to individuals and families, but it must also occur on a larger scale through care provided to communi- ties and population groups. Population and Community Health Nursing, Sixth Edition, provides population health nurses with the knowledge needed to intervene at these levels. This knowl- edge is theoretically and scientifically sound, yet practical and applicable to society’s changing demands.

Nursing Excellence Through Advocacy Like prior editions, this edition focuses on the central facet of population health nursing—advocating for the health of the public. The theoretical concept of advocacy is introduced in Chapter 1 and is based on qualitative research by the author that examines the process of advocacy as it is performed by population health nurses. Practical application of the concept occurs in each of the subsequent chapters.

Advocacy Then and Advocacy Now The Advocacy Then and Advocacy Now vignettes that open each chapter showcase the efforts of population health nurses,

other health professionals, and members of the lay public to advocate for the health of populations. Some of the Advocacy Now vignettes were contributed by population health nurses and are gratefully acknowledged. Other vignettes celebrate the past and present contributions of population health nurses and others to promoting health and addressing health needs in the United States and the world. We offer our appreciation to these contributors for their heartfelt descriptions of nursing in the population and for their generosity in permitting us to tell their stories. The Advocacy Now vignette that opens Chapter 2 de- scribes the work of Susie Walking Bear Yellowtail, the first Na- tive American registered nurse and an exemplary population health nurse advocate. The other stories, past and present, are equally inspiring for the population health nurses of today and those in the ages to come.

Population and Community Health Nursing, Sixth Edition, provides students with a strong, balanced foundation for pop- ulation health nursing practice. The book is designed to help students first achieve excellence in the classroom through the many features and exercises that accompany the narrative. The additional tools and supplemental information will help stu- dents succeed at applying those concepts in clinical settings with families, communities, and population groups, with the ultimate goal of preparing nurse generalists who will exhibit nursing excellence in any setting.

The underlying intent of this book is to convey to nurs- ing students at the beginning of the 21st century the excite- ment and challenge of providing nursing care to populations. As we begin a new era of population health nursing, I believe that well-educated population health nurses can provide a fo- cal point for resolution of the global health problems presented throughout the book. Early population health nurses changed the face of society; we can be a strong force in molding the so- ciety of the future by striving for nursing excellence through advocacy.

Organization This textbook is designed to present general principles of population health nursing and to assist students to apply those principles in practice. It is organized in five units. The first three units address general concepts and strategies of popula- tion health nursing practice, and the last two examine the ap- plication of those concepts to specific populations, settings, and population health problems.

UNIT I sets the stage for practice by describing popula- tion health nursing and the context in which it occurs. Read- ers are introduced to population health nursing as an area of

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vi Preface

specialized practice and to its emphasis on advocacy for the health of individuals, families, and population groups. The attributes and features that make population health nursing unique, standards for practice, and typical roles and func- tions of population health nurses are addressed. Then, the concept of populations as recipients of nursing care and the historical and theoretical underpinnings and development of population health nursing are presented followed by a discus- sion of epidemiology as a core content area for population health care.

A unique feature of this book is the consistent use of the Population Health Nursing model to structure the discussion of principles of practice. The model is introduced in Chapter 1. Further Information about other theoretical models that may be useful in population health nursing practice is provided in ancillary materials found at www.nursing.pearsonhighered .com. Other relevant models dealing with epidemiology, family nursing, health promotion, and so on, are included in specific chapters.

The population health nursing (PHN) model is used as the organizing framework for most of the chapters in the book, providing students with a systematic approach to determining factors that influence health and relevant strategies designed to promote health, prevent illness and injury, resolve existing health problems, and restore health in individuals, families, communities, and populations. The consistent use of the PHN model permits students to readily identify commonalities and differences among processes, populations, settings, and health problems.

UNIT II examines influences on population health and ad- dresses environmental, cultural, economic, healthcare delivery system, and global influences on population health. Knowledge of the influence of these factors on population health leads to the application of specific strategies to improve population health addressed in UNIT III. Strategies addressed include po- litical, empowerment, health promotion and health education, case management, and home visiting approaches to population health nursing as a specialized area of practice. Other aspects of population health nursing practice (e.g., community engage- ment, referral, delegation, social marketing, group dynamics, and leadership) are integrated into these and other chapters as appropriate.

UNIT Iv addresses health care provided to special popu- lation groups. In each chapter, students are assisted to apply principles of care to individuals and families, as well as to these populations as aggregates. For example, Chapter 16 emphasizes population health nursing care for children and adolescents as population groups, as well as strategies for improving the health of individual children and adolescents. Similar approaches are taken to other population groups in the unit: families, com- munities, men, women, the elderly, the GLBT population, and people experiencing poverty and homelessness.

UNIT Iv also addresses population health nursing in spe- cialized settings such as the school, work, correctional, and di- saster settings. For example, Chapter 22 examines the role of the

population health nurse in school settings, whereas Chapter 23 addresses employee health in the work setting. In each chapter in the unit, students are guided in the use of the nursing pro- cess and application of the PHN model in the special practice setting. Consideration is given to factors influencing determi- nants of health in each setting, and population health nursing interventions related to health promotion, illness and injury prevention, resolution of existing health problems, and health restoration are discussed.

UNIT v focuses on population health nursing practice re- lated to the control of common population health problems such as communicable diseases, chronic physical and men- tal health conditions, substance abuse, and societal violence. Again, students are assisted to apply the nursing process and the PHN model to identify factors contributing to problems in each of these areas and in designing nursing interventions at each of the four levels of health care. Consideration is given to the care of individuals and families with these problems as well as to resolving common health problems at the population level.

How to use this book to foster success in POPULATION HEALTH advocacy

The various features in the sixth edition of Population and Community Health Nursing provide tools to help you succeed in the classroom and in practice. They offer opportunities to apply the principles presented in the book in real and virtual practice settings, promoting your ability to be an advocate for health at multiple levels.

Learning Outcomes Learning outcomes at the beginning of each chapter help you to focus on the outcomes expected of you in relation to your knowledge and application of principles of population health nursing. They highlight the important content for each chapter and assist you in applying the PHN model to specific circum- stances and settings.

Key Terms The list of key terms at the beginning of each chapter alerts you to significant concepts to be addressed in the chapter, concepts with which an effective population health nurse needs to be fa- miliar. At the point of definition within the chapter, each term is set in boldface type.

Healthy People 2020: Objectives for Population Health These boxes present relevant objectives from Healthy People 2020 to familiarize you with these important population health goals. You also learn about the current status of objectives here

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and sources of further information on the objectives on the Nursing Portal for students at www.nursing.pearsonhighered .com.

Focused Assessments These boxes present a series of questions that assist you in conducting health assessments focused on a particular client, specific population groups, or particular aspects of care. They are framed in the context of determinants of health included in the PHN model and help you to tailor your nursing assessment to the specific needs of the client population, setting, or health problem addressed in the chapter.

Global Perspectives This feature presents an international view of population health nursing practice, examining issues that affect health throughout the world. The feature also addresses differences in population health nursing as practiced outside the United States and highlights global solutions to health problems facing mankind.

Evidence-Based Practice These boxes discuss the evidence base (and sometimes the lack of evidence) that underlies specific aspects of population health nursing practice. They also pose questions that stimulate think- ing about the development or critical review of the evidence base for practice.

Client Education These boxes identify important content for educating clients and the public regarding particular health issues and topics, equipping you for successful clinical encounters as you begin your career.

Highlights A feature intended to aid your review of content from the chap- ter; these bulleted summaries of main points or special foci ap- pear periodically in the text.

Case Studies Each chapter concludes with a case study designed to assist you to apply the principles addressed in the chapter to the real world of population health nursing practice. Many of the case studies foster application of the PHN model in clinical prac- tice with individual, families, and/or population groups. Each case study is followed by questions designed to promote critical thinking in practice.

References References contained in each chapter present an up-to-date pic- ture of principles and concepts related to the topic presented. References provide a balanced view of population health nurs- ing, exploring a variety of issues from several perspectives, and

provide a wide range of supplemental materials, including re- search reports, for the interested reader.

Additional Student Resources A variety of supplemental information and assessment tools are provided on the Nursing Portal for students at www.nursing .pearsonhighered.com. The site includes the following features:

• Testing Your Understanding: This feature assists you in evaluating your comprehension of concepts and principles presented in each chapter and assessing your achievement of the chapter learning outcomes. Questions are open-ended to facilitate thought and discussion.

• Clinical Reasoning Questions: Additional short answer questions are provided to assist readers in applying content from the chapters and to promote clinical reasoning. These questions maintain a balance between application of prac- tice concepts to individuals/families and population groups.

• Exam Review Questions: Multiple-choice review questions are provided for each chapter to assist readers in evaluating their comprehension of chapter content.

• Assessment Guidelines: The Nursing Portal for students also contains a wide variety of assessment tools and guide- lines to assess the health needs of individuals, families, and population groups in a variety of settings. Formerly included in a separate companion text, these tools and guidelines are made available to assist you with the practical aspects of as- sessing the health needs of various populations as well as in- dividual clients and their families. Most of the guidelines are organized around the elements of the PHN model, making it even easier to apply the model to a variety of client popu- lations, settings, and population health issues. Tools range from comprehensive assessment and intervention guides for care of specific population groups (e.g., children and ado- lescents, prisoners) or in specific settings (e.g., schools) to more specialized assessments (e.g., fall risk assessment in the elderly or client suitability for case management services). The tools and guidelines can be downloaded for immediate use in practice.

• Cultural Considerations: Relevant cultural considerations are provided for each chapter of the book to assist you in developing expertise in caring for a wide variety of culturally and ethnically diverse populations.

• Further Information: For some chapters, the Nursing Portal for students contains additional information related to chap- ter topics that may be of interest to readers. As noted earlier, additional information about other theoretical models for population health nursing is provided in this feature. Simi- larly, detailed cultural information tables are provided for a wide variety of cultural groups, including ethnic groups, healthcare professionals, and the dominant U.S. culture.

• Resource Exchange: This section of the Nursing Portal for students provides resources for further information on a va- riety of topics addressed in the book.

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viii Preface

Instructor Resources • Test Bank: An electronic test generator with questions for

each chapter is available for instructors to download from the Instructor Resource Center via the Nursing Portal.

• Instructor’s Resource Manual: This guide, available in the Instructor Resource Center, provides a wealth of helpful in- formation for planning learning opportunities for students.

Included are learning objectives that provide instructors with student goals for each chapter. Suggested classroom ac- tivities promote student participation in learning and help bring community health nursing practice to life.

• Lecture Note PowerPoints: PowerPoint slides for each chapter are available to instructors in the Instructor Re- source Center to help convey key points to students in class and facilitate discussion.

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Contents

Preface v

Unit 1 Population Health Nursing: An Overview 1

Chapter 1 Population Health and Nursing 2 Defining Populations as a Focus for Care 3 Defining Population Health 4 Population Health Practice 5

Core Public Health Functions 5 Essential Public Health Services 5

Objectives for Population Health 6 Nursing and Population Health: Labeling the Specialty 10 Population Health Nursing as Advocacy 10

Defining Advocacy 10 Advocacy by Population Health Nurses 11 The Advocacy Process 11 Population Health Nursing Functions in the Advocacy Role 12

Population Health Nursing Standards and Competencies 13 Population Health Nursing Education 14 A Population Health Nursing Model 14

Determinants of Population Health 15 Population Health Nursing Interventions 20 Levels of Health Care 24

Chapter 2 Population Health Nursing: Yesterday, Today, and Tomorrow 29

Historical Roots 31 The Influence of Christianity 32

The Early Christian Church 32 The Middle Ages 32

Other Religious Influences 33 The European Renaissance 33 A New World 33

The Colonial Period 33 Early Public Health Efforts 34

The Industrial Revolution 34 Nursing in War 37 District Nursing in England 37 Visiting Nurses in America and the World 38 Nursing and the Settlement Houses 38 Expanding the Focus on Prevention 39 Standardizing Practice 42 Educating Population Health Nurses 42 Federal Involvement in Health Care 44

The Latter Half of the 20th Century 45 The Present and Beyond 47

Chapter 3 Epidemiology and Population Health Nursing 53

Basic Epidemiologic Concepts 55 Causality 56 Risk 57 Rates of Occurrence 58

The Epidemiologic Process 60 Defining the Condition 60 Determining the Natural History of the Condition 60 Identifying Strategic Points of Control 61 Designing, Implementing, and Evaluating Control Strategies 62

Epidemiologic Investigation 62 Descriptive Epidemiology 62 Analytic Epidemiology 63 Experimental Epidemiology 63

Epidemiologic Models 64 The Epidemiologic Triad Model 64 The Web of Causation Model 67 Determinants-of-Health Models 67

Unit 2 Influences on Population Health 71 Chapter 4 Environmental Influences on Population

Health 72 Environment and Health 73 Components of the Human Environment 78

The Natural Environment 78 The Built Environment 85 The Social Environment 87 Interactions Among Environmental Components 90

Population Health Nursing and Environmental Influences on Health 91

Assessing Environmental Health Influences 91 Planning to Address Environmental Health Issues 94 Evaluating Environmental Health Measures 98

Chapter 5 Cultural Influences on Population Health 102

Basic Concepts Related to Culture and Health 104 Culture and Health 106

Ethnic/Societal Culture and Health 107 Biomedical Culture and Health 107

Ethnic Diversity in the United States 108

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Assessing Cultural Influences on Health and Health Care 109 Principles of Cultural Assessment 109 Obtaining Cultural Information 109

Cultural Assessment Data 111 Biological Determinants 111 Psychological Determinants 113 Environmental Determinants 115 Sociocultural Determinants 116 Behavioral Determinants 126 Health System Determinants 127

Planning Culturally Congruent Care and Delivery Systems 135 Cultural Competence 136

Evaluating Cultural Competence 140

Chapter 6 Economic Influences on Population Health 144

Economics and Health—The Interrelationships 146 Societal Productivity and Stability 146 Health Care Spending 146 Socioeconomic Factors and Health Status 148

Health Care Reimbursement Systems 150 Retrospective Reimbursement 150 Prospective Reimbursement 152 Capitation 152 Pay-for-Performance 152

Health Care Funding Sources 153 Personal Payment 153 Commercial Insurance 153 Government-Funded Care 157 Charity Care 161

Health Insurance and Reform 161 Health Care Reform and Population Health 162

Chapter 7 Health System Influences on Population Health 167

The U.S. Health Care System 169 Forces Influencing the Health Care System 169 Components of the U.S. Health Care System 170 U.S. Health System Reform 176

Other National Health Care Systems 179 Public Health Functions: An International Perspective 179 Features of Selected National Health Systems 179 Comparing Health System Outcomes 183

Chapter 8 Global Influences on Population Health 187 Globalization 189

Dimensions of Globalization 189 Health Effects of Globalization 190

International and Global Health Perspectives 191 Trends in Global Health Collaboration 191 U.S. Involvement and Global Health 193 Global Health Initiatives 193 Global Health Governance 194

Health Care Organization at Global and International Levels 196 Bilateral Agencies 196 Multilateral Agencies 197 Civil Society Organizations 198

Global Health Issues 199 Health Status Issues 199 Social Determinants of Health 203

Population Health Nursing and Global Health 206 Service Delivery 206 Framing Global Policy Issues 207 International Nursing Organizations 208

Unit 3 Population Health Nursing Strategies 213

Chapter 9 Political Strategies 214 Policy and Politics 216 Relationships Between Public Policy and Health 216 Types of Policies 217 Avenues for Public Policy Development 218

Legislation 218 Regulation 223 Administrative and Judicial Decisions 223 State Health Plans 224

Nursing and Policy Development 224 Spheres of Nursing Influence in Policy Development 225 Principles of Policy Development 225 The Policy Development Process 225 Population Health Nursing Roles and Policy Development 226 Applying the Population Health Nursing Model to Policy Development 226

The Patient Protection and Affordable Care Act—PL 111–148 235

Chapter 10 Community Empowerment Strategies 239 Empowerment and Related Concepts 241 Levels of Empowerment 242 Models for Community Empowerment 243 Population Health Nursing and Community Empowerment 244

The Population Health Nurse’s Role in Fostering Empowerment 244 Assessing Community Strengths and Needs 245 Planning and Implementing Empowerment Strategies 245 Evaluating Community Empowerment 251

Chapter 11 Health Promotion and Education Strategies 256

Defining Health Promotion 258 The Need for Health Promotion 259 Models for Health Promotion 259

The Precaution Adoption Process Model 260 The Theories of Reasoned Action and Planned Behavior 261 The Health Belief Model 261 Pender’s Health Promotion Model 262

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Contents xi

Population Health Nursing and Health Promotion 263 Factors Influencing Health Promotion 263 Strategies for Health Promotion 265 Evaluating Health Promotion Programs 279

Chapter 12 Case Management Strategies 285 Defining Case Management 287 Case Management Models 288 Standards and Principles of Case Management 288 Competencies and Functions of Case Managers 289 The Case Management Process 290 Ethical and Legal Issues in Case Management 291 Case Management and Health Care Reform 292 Population Health Nursing and Case Management 292

Assessing the Need for Case Management 293 Assessing the Case Management Situation 293 Planning and Implementing Case Management Strategies 294 Evaluating the Process and Outcomes of Case Management 298

Chapter 13 Home Visits as a Population Health Nursing Strategy 303

Defining a Home Visit and Types of Home Visits 305 Advantages and Disadvantages of Home Visits 305 Home Visiting Programs 306 The Home Visit Process 307

Initiating the Home Visit 307 Conducting a Preliminary Health Assessment 308 Deriving Nursing Diagnoses 309 Planning the Home Visit 309 Implementing the Planned Visit 312 Evaluating the Home Visit 314 Documenting Home Visits 315 Termination 315

Home Visits in the Home Health and Hospice Contexts 316 Collaboration in Home Health and Hospice Care 317 Technology and Home Care Services 317 Funding Home Health and Hospice Services 318 Licensing of Home Health and Hospice Services 318 Standards for Home Health and Hospice Nursing 319 Evaluating Home Health and Hospice Services 319

Unit 4 Nursing Care of Special Populations 325

Chapter 14 Care of Families 326 Theoretical Perspectives on Family 328

Systems Models 328 Family Life Cycle Theory 329 Symbolic Interactionism 330

The Family as a Unit of Care 331 Defining Family 331 Family Types 331

Population Health Nursing and Care of Families 332 Assessing Family Health Status 333 Diagnostic Reasoning and Care of Families 347 Planning and Implementing Health Care for Families 347 Evaluating Family Care 349

Chapter 15 Care of Communities and Target Populations 352

Community Engagement and Population-Based Health Initiatives 354

Benefits of Engagement 355 Models for Engagement 355 Principles of Engagement 356 Developing a Comprehensive Community Engagement Strategy 356

Nursing Care of Populations 356 Assessing Population Health Status 357 Deriving Population-Level Nursing Diagnoses 370 Planning Population-Based Health Initiatives 370 Implementing Population-Based Health Initiatives 377 Evaluating Population-Based Health Initiatives 378

Chapter 16 Care of Child and Adolescent Populations 388

Health Issues for Children and Adolescents 390 Child and Adolescent Mortality 390 Preterm Births 390 Injury 390 Communicable Diseases 391 Chronic Conditions 392 Psychological and Behavioral Health Problems 392 Developmental Disorders 393 Violence 394

Population Health Nursing Care of Child and Adolescent Populations 394

Assessing the Health of Child and Adolescent Populations 394 Diagnostic Reasoning and the Health of Child and Adolescent Populations 403 Planning and Implementing Health Care for Child and Adolescent Populations 404 Evaluating Health Care for Child and Adolescent Populations 417

Chapter 17 Care of Men 424 Population Health Nursing and Care of Men 426

Assessing the Health Status of Men 426 Diagnostic Reasoning and Men’s Health 436 Planning to Meet the Health Needs of Men 436 Evaluating Health Care for Men 440

Chapter 18 Care of Women 446 Population Health Nursing and Women’s Health 448

Assessing the Health Status of Women 448 Diagnostic Reasoning and Women’s Health 462

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Planning to Meet the Health Needs of Women 463 Evaluating Health Care for Women 468

Chapter 19 Care of the Older Population 475 Theoretical Perspectives on Aging 478 Population Health Nursing and Care of Older Populations 479

Assessing the Health Status and Needs of Older Populations 479 Diagnostic Reasoning and Care of Older Populations 499 Planning to Meet the Health Needs of Older Populations 500 Implementing Care for Older Populations 514 Evaluating Health Care for Older Populations 516

Chapter 20 Care of Gay, Lesbian, Bisexual, and Transgender Populations 525

Sexual Orientation and Gender Identity 526 Determining the Size of the GLBT Population 528 Population Health Nursing and Care of GLBT Populations 529

Assessing the Health of GLBT Populations 529 Planning and Implementing Health Care for the GLBT Population 543 Evaluating Health Care for the GLBT Population 545

Chapter 21 Care of Poor and Homeless Populations 551 Overview of Poverty and Homelessness 553

Defining Poverty and Homelessness 553 The Magnitude of Poverty and Homelessness 555

Population Health Nursing and Care of Poor and Homeless Populations 556

Assessing the Health of Poor and Homeless Populations 556 Diagnostic Reasoning and Care of Poor and Homeless Populations 570 Planning and Implementing Health Care for Poor and Home- less Populations 571 Evaluating Care for Poor and Homeless Populations 577

Chapter 22 Care of School Populations 582 Historical Perspectives 584 The School Health Team 585

The School Nurse 585 Other Team Members 586

Population Health Nursing and Care of School Populations 588 Assessing the Health of School Populations 588 Diagnostic Reasoning and Care of School Populations 604 Planning and Implementing Services to Meet the Health Needs of School Populations 605 Evaluating Health Care for School Populations 616

Chapter 23 Care of Employee Populations 624 Occupational Health Nursing 626

Educational Preparation for Occupational Health Nursing 627 Standards and Competencies for Occupational Health Nursing 627 Occupational Health Nursing Roles 627

Population Health Nursing and Care of the Working Population 628 Assessing the Health Status of the Working Population 628 Diagnostic Reasoning and Care of Working Populations 646 Planning and Implementing Care for Working Populations 647 Evaluating Health Care in Work Settings 657

Chapter 24 Care of Correctional Populations 663 The Correctional Population 665 The Need for Correctional Health Services 666 Population Health Nursing and Correctional Health 667

Assessing the Health Status of Correctional Populations 667 Diagnostic Reasoning and Care of Correctional Populations 680 Planning and Implementing Health Care for Correctional Populations 680 Evaluating Health Care for Correctional Populations 692

Chapter 25 Care of Populations Affected by Disaster 696

Defining and Categorizing Disasters 697 Disaster Trends 700 Characteristics of Disasters 701 The Disaster Role of the Public Health System 703 Elements of a Disaster Event 703

The Temporal Element: Stages of Disaster Response 703 The Spatial Element 706 The Role Element 711 The Effects Element 711

Population Health Nursing and Disaster Care 711 Disaster-related Assessment 712 Diagnostic Reasoning and Care of Populations in Disaster Settings 720 Planning: Disaster Preparedness 722 Implementing Disaster Care 733 Evaluating Disaster Preparedness and Response 734

Unit 5 Population Health Issues 739 Chapter 26 Communicable Diseases 740 General Concepts Related to Communicable Diseases 743

Chain of Infection 743 Modes of Transmission 743 Portals of Entry and Exit 744 Incubation and Prodromal Periods 745 Immunity 745 Other Communicable Disease Concepts 745

Trends in Communicable Diseases 746 Vaccine-preventable Diseases 746 Sexually Transmitted Infections 749 Viral Hepatitis 749 Tuberculosis 750 Food and Waterborne Diseases 750

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Contents xiii

Bloodborne Diseases 751 Arthropodborne (Arboviral) Diseases 751 Emerging Diseases 752

Population Health Nursing and Communicable Disease Control 752 Assessing Determinants of Health in Communicable Disease 752 Diagnostic Reasoning and Control of Communicable Diseases 763 Planning and Implementing Control Strategies for Communi- cable Diseases 764 Evaluating Communicable Disease Control Strategies 779

Chapter 27 Chronic Physical Health Problems 791 Individual, Family, and Societal Effects of Chronic Physical Health Problems 793

Individual Effects 793 Family Effects 794 Societal Effects 795

Population Health Nursing and Chronic Physical Health Problems 797

Assessing Risks for and Effects of Chronic Physical Health Problems 797 Diagnostic Reasoning and Control of Chronic Physical Health Problems 812 Planning and Implementing Control Strategies for Chronic Physical Health Problems 812 Evaluating Control Strategies for Chronic Physical Health Problems 826

Chapter 28 Mental Health and Mental Illness 836 Individual, Family, and Societal Effects of Chronic Mental Health Problems 838

Personal Effects 838 Family Effects 838 Societal Effects 838

Trends in Mental Health Problems 839 Population Health Nursing and Mental Health and Illness 842

Assessing Mental Health Status 842 Diagnostic Reasoning and Mental Health and Illness 853 Planning and Implementing Strategies Related to Mental Health and Illness 853 Evaluating Interventions for Mental Health and Illness 859

Chapter 29 Substance Abuse 866 Individual, Family, and Societal Effects of Substance Abuse 868

Individual Effects 868 Family Effects 870 Societal Effects 871

Trends in Substance Use and Abuse 872 Population Health Nursing and Substance Abuse 876

Assessing Risks for and Effects of Substance Abuse 876 Diagnostic Reasoning and Control of Substance Abuse 890 Planning and Implementing Control Strategies for Substance Abuse 890 Evaluating Control Strategies for Substance Abuse 899

Chapter 30 Societal Violence 907 Trends in Societal Violence 910

Self-Directed Violence 910 Interpersonal Violence 911

Population Health Nursing and Societal Violence 916 Assessing Risks for and Effects of Societal Violence 916 Diagnostic Reasoning and Societal Violence 927 Planning and Implementing Control Strategies for Societal Violence 927 Evaluating Control Strategies for Societal Violence 933

Index 939

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1 — Population Health and Nursing

2 — Population Health Nursing: Yesterday, Today, and Tomorrow

3 — Epidemiology and Population Health Nursing

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Population Health Nursing: An Overview

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chaPter

Population Health and Nursing

Key Terms

Learning Outcomes

After reading this chapter, you should be able to:

1. Define population health and population health nursing.

2. Describe the Healthy People 2020 national objectives for population health.

3. Describe advocacy as a critical function of population health nurses.

4. Summarize the standards for population health nursing practice.

5. Identify the eight domains of competency for population health nursing.

6. Describe the components of the population health nursing (PHN) model.

7. Describe a systematic process for implementing evidence-based population health nursing practice.

advocacy

aggregates

assessment

assurance

case finding

case manager

clinical practice guidelines

coalition building

collaboration

community

community mobilization

coordination

counseling

education

evidence-based practice

geopolitical community

health determinants

health promotion

liaison

neighborhood

policy advocate

policy development

population health

population health management

population health nursing

populations

prevention

primary prevention

referral

resolution

restoration

role model

secondary prevention

social capital

social marketing

surveillance

tertiary prevention

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3

A Picture Is Worth a Thousand Words

Residents of a small community and staff members of local health and social service agencies in a small southern California community were involved in an assessment of community health status and health needs. One of the concerns voiced most often by community members were discrimina- tory practices by absentee landlords in which tenants, many of whom were newly arrived immigrants, were evicted if they complained about needed repairs and safety hazards. Because many of them had arrived in the United States from countries with repressive regimes, the residents were reluc- tant to present their concerns to the local housing authority. The local public health nurse, who was well respected in the community and knowledgeable about many housing code violations, took pictures of violations in the homes of many of her clients. Her pictures depicted stoves situated immediately next to walls without adequate ventilation, stairs in poor repair, stairs without hand- rails, and bars on windows that prevented escape in the event of fire. Armed with her pictures, the Community Collaborative held a town forum to which they invited members of the local housing authority. The pictures graphically reinforced the concerns voiced by community members at the meeting. As a result, the housing authority acted on a number of code violations, which encour- aged community members to report other safety issues. In addition, the efforts of the Collaborative resulted in the creation of a city-funded position of housing ombudsman to assist residents in deal- ing with a variety of housing issues.

Florence Nightingale and Population Health

Florence Nightingale, considered the founder of modern nursing practice, was also a consummate advocate for population health. In her work in the Crimean War, she was a strong advocate for both the use of statistics to provide a population level of health and of environmental sanitation to improve the conditions of the ill and injured (Lewis, 2010). Ms. Nightingale used her influential media con- tacts with The Times of London to force the British government to support women’s involvement in care of the sick and injured soldiers (Simkin, n.d.). Throughout her career, she continued to advocate for social conditions that promoted health and was influential in creating the system of district nurs- ing that was the British version of public health nursing. She also was instrumental in workhouse reform in England (Workhouse, n.d.) and in the establishment of the Indian Sanitary Department to deal with environmental sanitation in India (Bloy, 2010). In a letter to a friend, Nightingale wrote of the need for nursing advocacy, stating “One’s feelings waste themselves in words; they ought all to be distilled into actions . . . which bring results” (cited in Hallett, 2010, p. 50).

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Emphasis on the health of populations as a focus for care arose out of growing evidence that individual-oriented health care has only limited effects on improving the health of the general pub- lic. A population health focus may occur at a variety of levels, and populations may encompass smaller or larger groups of people.

Defining Populations as a Focus for Care Populations are groups of people, who may or may not inter- act with each other, but who have common health concerns and needs. According to the second edition of the American Nurses Association (ANA) Public Health Nursing: Scope and

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4 unit 1 Population health nursing: an Overview

Standards of Practice, a population, in the population health nursing context, refers to the residents of a specific geographic area, but the population health nurse’s focus may include spe- cific targeted groups of people with some trait or attribute in common (e.g., a minority group, employees, the elderly) or who “may be at risk for, experience, a disproportionate bur- den of poor health outcomes” (ANA, 2013, p. 3). Three other commonly used, similar, but different terms for these smaller subgroups are neighborhood, community, and aggregate.

A neighborhood is a smaller, frequently more homoge- neous group than a community that involves an interface with others living nearby and some level of identification with those others. Neighborhoods are self-defined, and although they may be constrained by natural or man-made factors, they often do not have specifically demarcated boundaries. For example, a major highway may limit interactions between residents on either side, thus creating separate neighborhoods. Or a neigh- borhood may be defined by a common language or cultural heritage. Thus, non-Hispanic residents of a “Hispanic neigh- borhood” are not usually considered, nor do they consider themselves, part of the neighborhood.

A community may be composed of several neighbor- hoods. Some people define communities in terms of specific geographic locations or settings, but most definitions of com- munity go beyond locale as a primary defining characteris- tic. In addition to location, other potential defining aspects of communities include a social system or social institutions designed to carry out specific functions; identity, commit- ment, or emotional connection; common norms and val- ues; common history or interests; common symbols; social interaction; and intentional action to meet common needs. A community is described as an “interactional whole” differ- ent from the people who comprise it (ANA, 2013, p.65). For our purposes, then, a community is defined as a group of people who share common interests, who interact with each other, and who function collectively within a defined social structure to address common concerns. By this definition, geopolitical entities, such as the city of San Diego, a school of nursing, and a religious congregation can be considered communities. A geopolitical community is one character- ized by geographic and jurisdictional boundaries, such as a city.

Aggregates are subpopulations within the larger popula- tion who possess some common characteristics, often related to high risk for specific health problems. School-aged children, persons with human immunodeficiency virus (HIV) infection, and the elderly are all examples of aggregates.

Population health nurses may work with any or all of these population groups—aggregates, neighborhoods, and communities—in their efforts to enhance the health sta- tus of the general public or overall population. Population health addresses the health needs of entire groups, and those health needs are affected by factors influencing indi- viduals, families, neighborhoods and communities, as well as the society at large. Issel and Bekemeier (2010) used the

population-patient to reflect this focus on providing care at the population level.

Defining Population Health The health of a population goes beyond the health status of the individuals or subgroups that comprise it, but involves the collective health of the group. Several authors have noted the lack of a precise definition of population health, but note that definitions range from health outcomes affecting total popula- tions defined by geography (e.g., a county or state) to “account- ability for health outcomes in populations defined by health care delivery systems such as health plans or Accountable Care Organizations” (Stoto, 2013, p. 2). This latter perspective re- quires health care systems to address “upstream” factors such as health promotion and illness and injury prevention as well management of disease. Both of these perspectives embody a “population health perspective” characterized by conceptual- ization of the population as a unit separate from its members, incorporation of upstream factors in measures of population health, and the goal of reducing disparities within the popu- lation. Other characteristics of a population health perspective include consideration of a broad array of determinants or fac- tors that influence health and recognition that responsibility for population health is shared by many segments of society that must work collaboratively to achieve health, because none of them can do so alone (Stoto, 2013).

Thirty years ago, the World Health Organization conceptu- alized population health as both a measure of the health sta- tus of a given population and “a resource for everyday life, not the object of living. Health is a positive concept, emphasizing social and personal resources as well as physical capacities.” (World Health Organization, 1984, p. 1).