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Nurses on the frontline

Improving community health

Kiper, Valerie DNP, MSN, RN, NE-BC; Geist, Rebecca DNP, MSN, RN, PHNA-BC

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Nursing Made Incredibly Easy!: May/June 2020 - Volume 18 - Issue 3 - p 22-26
doi: 10.1097/01.NME.0000658188.17482.9a
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Nurses in community/public health practice have an opportunity to share their expertise related to population-based approaches for groups and individuals not only in their communities, but also across all healthcare settings. To provide population-based care, community/public health nurses require additional skills in community assessment, identification of community resources, and development of targeted community partnerships to promote policy development that enhances access to care. This article provides strategies to shift the care focus to population-based community health.

A diverse role

Community/public health nurses develop strategies and interventions that target entire population groups, families, or individuals, adapting to the various populations they serve, as well as the setting in which they care for patients. They provide care in patients' homes in urban and rural communities and at organized events, agencies, and institutions that serve people with specific health needs. Settings include community health clinics, community nursing centers, schools, churches, housing developments, local and state health departments, neighborhood centers, homeless shelters, and work sites. Regardless of the practice setting, they focus on preventing illness, injuries, or disabilities and promoting good health.

Vulnerable and high-risk populations are often the focus of care, which includes homeless individuals, veterans, patients with disabilities, older adults, teen mothers, pregnant women, smokers, infants, children, adolescents, and those at risk for a specific disease. Recently, migrant populations who present with communicable illnesses, lack of immunizations, and housing instability are a primary focus in the community health sector.

Taking a community survey

For community/public health nurses to make an impact on the health and wellness of their communities, they should become familiar with the attributes affecting the health of individuals in those communities. Community/public health nurses will often conduct a community windshield survey by driving or walking through an area or defined neighborhood and making several observations to assist with gaining a deeper understanding of the environmental blueprint.

A windshield survey includes observing geographic features, such as green spaces and parks, as well as the locations of industries, various healthcare agencies, businesses, and schools (see Elements of the community windshield survey). Through this down-to-earth approach, community/public health nurses can establish certain concepts about the community's health, strengths, and potential health problems. Not only does the windshield survey allow for an exploration of vulnerabilities that affect community health, but it may also be used to collaborate with community health experts who are knowledgeable about the health of their community. Community/public health nurses work with diverse partners and healthcare providers, including acute care staff such as discharge planners, public health officials in charge of community emergency management, school nurses, social workers, and paramedics/emergency technicians, to address complex healthcare challenges.

Once the windshield survey is completed, the nurses can begin to explore the following questions: What's the priority health problem in the community? What assessment data/evidence led community health experts to identify this issue as the priority problem? Based on the synthesis of the community windshield survey and information obtained from other community health experts, community/public health nurses establish a community nursing diagnosis to target specific population care and prevention strategies.

Establishing a community diagnosis

Nurses implement care plans every day while caring for their patients in all settings utilizing the NANDA (formerly the North American Nursing Diagnosis Association) approach to creating a nursing diagnosis. In public health nursing, nurses look at the bigger picture and create a community nursing diagnosis. One of the first steps in establishing the healthcare needs of a community is to understand its culture, values, attitudes, and practices. Consulting a key informant who knows the people and the community is imperative.

A community diagnosis includes disability/disease, the cause of the disease or condition, and health indicators. The following is an example of a community diagnosis with possible interventions:

  • Increased risk of: Diabetes complications
  • Among: Older residents with diabetes in the Apple community and Orange Independent School District
  • Related to: Poorly controlled diabetes
  • As demonstrated by: Increasing diagnosis of diabetes within the community and the need for home health assistance with blood glucose management
  • Proposed interventions: Home health services can provide quarterly community meetings with updates on diabetes education, group shopping trips, and tips on cooking diabetes-friendly meals.
Table
Table:
Elements of the community windshield survey

For this community, the health priority is improving the older adult population's diabetes management. Through the windshield survey, it was found that many older adults take care of their grandchildren and visit the school nurse clinic for education regarding their diabetes. Some come to the elementary school and walk on “Walking Wednesdays” with their grandchildren. However, some lacked education on the management of their food intake and many can't afford glucose test strips or insulin.

Defining Healthy People 2020 goals

In addition to the community diagnosis, incorporating the goals of the Healthy People 2020 initiative can help monitor and track health status and risks and guide the use of health services. The aims of Healthy People 2020 are the promotion of healthy behaviors and healthy and safe communities, improvement of systems for personal and public health, reduction of diseases and disorders, achievement of health equity by eliminating disparities, and better health of all groups.

The Healthy People 2020 leading health indicators were selected and organized using social determinants across the life stages to draw attention to health disparities that affect the public's health from infancy through old age. Biological, social, economic, and environmental factors and their interrelationships influence the ability of individuals and communities to make progress on identified health indicators. Health and disease result from the effects of risk factors and determinants over time. Intervening at specific points in the life course can help reduce risk factors and promote health. Notably, health disparities have become the focus of many local, state, and federal government studies over the past 2 decades.

The information gained through the windshield survey and the community diagnosis can be used to target Healthy People 2020 goals. In our example, older adults in the community need help with diabetes management. The Healthy People 2020 goals related to diabetes include:

  • Reduce the disease burden of type 2 diabetes and improve the quality of life for all persons who have, or are at risk for, it.
  • Testing and early diagnosis is important for unrecognized diabetes.
  • Access to proper diabetes care and education is important.
  • People from minority populations are more likely to be impacted by type 2 diabetes.
  • Testing A1C levels is now recommended for earlier diagnosis.

Dynamic and evolving care

Community/public health nurses merge their clinical knowledge with community involvement and outreach efforts in combination with utilizing robust tools and strategies to respond to health problems and promote overall health. They rely on critical thinking, advocacy, and analytical abilities to provide dynamic and evolving care that impacts the community in a positive way. Most important, they're in a unique position to influence policy development and implementation at the local, state, and national levels to promote health and improve the quality of life for all Americans.

REFERENCES

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Nies MA, McEwen M. Community/Public Health Nursing: Promoting the Health of Populations. 7th ed. St. Louis, MO: Elsevier/Saunders; 2018.
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      US Office of Disease Prevention and Health Promotion. Topics and objectives. http://www.healthypeople.gov/2020/topics-objectives.
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