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Introduction to Public Health Nursing

by Heide Cygan, DNP, RN

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    00:01 Today we're going to cover basic concepts in public health nursing, starting first by answering the question, what is public health nursing? First, I'd like to introduce you to George.

    00:11 George and I are both public health nurses.

    00:13 And we'll be guiding you through several important public health nursing concepts during the series.

    00:18 As public health nurses, George and I both work in the communities where we live.

    00:22 That means that we use our nursing expertise to address health concerns that are important to us and others in our community.

    00:30 Today, we're going to introduce public health nursing and share what makes this specialty so unique.

    00:37 Now, community health nursing and public health nursing often get mixed up.

    00:41 There are two terms that people use interchangeably, but there's a difference between the two.

    00:46 So let's break that down.

    00:48 On one side, we have community health nursing.

    00:51 On the other side, we have public health nursing.

    00:53 And right down the middle here, we have five areas in which the two are different.

    00:58 Let's start first by talking about the purpose.

    01:03 Community Health Nursing is generally focused on illness care for individuals or families in a particular community based setting.

    01:10 However, public health is more broad.

    01:13 It focuses on health care of communities and populations.

    01:16 It views the community or the population as the recipient of care rather than the individual.

    01:23 Goals here are also different.

    01:26 In community health nursing, the goal is management of acute or chronic conditions.

    01:30 In public health, the goal is prevention of disease and health promotion.

    01:37 Patient interaction also looks different between community health and public health.

    01:41 In community health, interactions are often one on one.

    01:44 Sometimes they're family based.

    01:46 In public health, interactions are at the organizational or community level.

    01:51 Types of services also vary.

    01:54 In community health, most services are direct patient care.

    01:58 In contrast, most public health nursing interventions are indirect.

    02:02 While some public health nursing roles include direct patient care, it also includes indirect care through program management and systems level leadership.

    02:12 Public health is really concerned about the interaction between the community or the population and their environment.

    02:19 And finally, levels of prevention.

    02:22 In community health nursing, the levels of prevention practice are mainly secondary and tertiary, maybe a little bit of primary prevention.

    02:29 In public health, however, the focus is mainly on primary prevention.

    02:35 Now that we've discussed the difference between community health, nursing and public health nursing, let's take a look at an example.

    02:41 We'll use fall prevention to differentiate the role of a community health nurse and a public health nurse.

    02:46 A community health nurse may conduct a physical assessment on an individual who is experienced a fall.

    02:52 They may also conduct an assessment of a home environment to determine how and why that fall occurred in the first place.

    03:00 Based on that assessment, a community health nurse will work closely with a family to develop a plan of care.

    03:06 Now that plan of care may include a number of different interventions.

    03:09 For example, it could include treating an injury that occurred as a result of the fall.

    03:14 So maybe there's a dressing change that needs to be done, the community health nurse would do that dressing change, and also teach the family members how to do that dressing change when they're not around.

    03:25 In addition, a community health nurse would also offer up some suggestions to prevent falls from occurring again.

    03:32 These suggestions could be related to the lighting in the home, making sure that there's appropriate lighting so that everyone can see where they're walking.

    03:39 They may also discuss things such as floor coverings and the use of nonstick rugs.

    03:45 When we think about secondary and tertiary prevention, another really great intervention is the use of a fall alarm.

    03:51 So that if an individual does fall, family members or emergency services are alerted that they need help.

    04:00 Now let's take a look at fall prevention from a public health nurses perspective, from George's perspective.

    04:06 Now, again, we're going to start out with an assessment because that's what nurses do.

    04:09 But George's assessment is going to look a little bit different.

    04:12 Rather than focus on an individual or a family, George is going to do a community assessment.

    04:17 And there's three parts to that community assessment.

    04:20 First, he'll conduct an environmental scan.

    04:22 This means he's going to walk around the community, he's going to look at things such as the conditions of the sidewalks, maybe he'll check to see if there's handrails near staircases.

    04:31 Next, he's going to collect some hard data.

    04:34 So maybe he'll go to a local emergency department and collect data related to falls in the community, looking at where people are falling, who's falling, what type of injuries have occurred as a result of falls.

    04:47 Next, George is going to conduct focus groups.

    04:49 He wants to learn directly from those who are at highest risk, what their concerns are about falls in the community.

    04:55 So maybe he'll go to a local senior center and talk to people there conduct focus groups to understand what they're specific concerns are.

    05:02 Now based on all these assessment data.

    05:05 Georgia is going to put together a treatment plan, a treatment plan for the community.

    05:09 And again, this can involve a number of different nursing interventions.

    05:12 It may include advocacy for changes in policy.

    05:16 It may include community wide education.

    05:18 It may include advocacy for changes to the local environment.

    05:22 So hopefully through this example, you've seen the difference between community health nursing and public health nursing.

    05:29 There are eight characteristics that define public health nursing.

    05:32 These are the characteristics that set us apart that make us unique from other specialties.

    05:38 First, and perhaps the most important is that we as public health nurses care unit of care as the population.

    05:46 This means that rather seen individual as our patient, we see an entire population as our patient.

    05:51 We seek to improve the health of that population through our nursing practice.

    05:58 Next, as public health nurses, we aim to do the greatest good for the greatest number of people.

    06:04 Now this may be different from the type of nursing that you're used to where your sole focus might be on one or just a few patients.

    06:10 With public health nursing, we do the greatest good for the greatest number of people.

    06:16 Next, we see the client as an equal partner.

    06:19 And remember, the client here is the population.

    06:22 This means that we seek and value input from all members of the population when designing, implementing and evaluating services.

    06:32 As I mentioned earlier, in public health we focus on primary prevention.

    06:36 This means that we aim to stop disease before it begins rather than treat it once it's established.

    06:42 Now there's the first four, we've got four more left.

    06:46 As public health nurses, we focus on strategies that create healthy environmental, social and economic conditions.

    06:53 This means that we consider factors other than healthcare that help keep people and populations well or make them ill.

    07:00 We see illness and wellness as multifactorial and we treat them as such.

    07:06 As public health nurses, we actively identify and reach out to all who might benefit from our services.

    07:11 This means that we advertise our services to anyone who might benefit rather than simply provide services to those who seek us out.

    07:19 We don't wait at a hospital or in a clinic for patients to come to us, we go to them.

    07:25 Okay, only two more to go.

    07:28 As public health nurses, we ensure that we're using resources wisely.

    07:31 Often we're using community level resources to deliver our services.

    07:35 Because of this, it's even more important to ensure that we're using them in a way that creates the most benefit and honors the priority of the community.

    07:44 And finally, here we are at number eight.

    07:46 Collaboration is essential in all types of nursing.

    07:49 It holds special value in public health nursing, as we know that we cannot do our work in communities alone.

    07:54 Being a public health nurse requires close collaboration with the community in which you work.

    08:01 As a reminder, although all eight characteristics are important, the most important is that as public health nurses, we see our client as the community.

    08:10 The community is our unit of care.

    08:15 Public health nurses serve communities through health promotion and disease prevention.

    08:20 Health Promotion includes all efforts that seek to move people closer to optimal well being or higher levels of wellness.

    08:27 We do this through a variety of different nursing interventions.

    08:30 Interventions can include direct individual patient care services, such as administering vaccines.

    08:37 Public health nurses also promote health through community and systems level approaches, such as collaborating to open a school based health center that provides a variety of services to young people in a community or advocating for policies that improve living conditions in the community.

    08:54 Through these health promotion activities, a public health nurse aims to do three different things.

    09:00 Increase the span of healthy life for all citizens, reduce health disparities among population groups, and finally, help achieve access to preventive services for everyone in the community.

    09:17 Public health nurses also work to improve health outcomes through disease prevention.

    09:21 There are three main levels of disease prevention, primary, secondary, and tertiary.

    09:26 These are explored in detail later in the series.

    09:31 Public health nurses work in a variety of different settings.

    09:35 And while it's important to know this, it's not the setting that defines public health nursing practice.

    09:39 Rather, it's the eight characteristics that we just talked about.

    09:43 Public health nurses are able to embody these characteristics in a variety of different settings through a variety of different interventions.

    09:49 Here are just a few examples.

    09:51 Public health nurses may work in mobile clinics, doing COVID-19 or other types of testing.

    09:57 Public health nurses may also use their expertise to work in occupational health.

    10:01 This means they work with groups of employees to ensure their working environment is safe and collaborate with them to optimize their health.

    10:10 Public health nurses often work around the globe.

    10:13 Through this work, they're able to improve global health outcomes through Disease Prevention and Health Promotion.

    10:20 Public health nurses also work in schools.

    10:22 In fact, school nurses are public health nurses by definition of the type of work they do.

    10:27 They see the school community as their unit of care and engage in a variety of direct and indirect activities that improve the health of individuals and populations within the school.

    10:38 As you can see, there are a lot of opportunities in public health nursing for you.

    10:42 Thanks for watching.


    About the Lecture

    The lecture Introduction to Public Health Nursing by Heide Cygan, DNP, RN is from the course Basic Concepts in Public Health Nursing (release in progress).


    Included Quiz Questions

    1. Providing healthcare for communities and populations.
    2. Illness care for individuals and families.
    3. Managing acute and chronic illnesses.
    4. One-on-one and family-based care.
    1. Public health care focuses more on disease prevention and health promotion.
    2. Public health provides care indirectly through program management.
    3. Community health is more focused on secondary and tertiary care.
    4. Public health focuses on care at the individual or family level.
    5. Community health focuses on care at the organizational and governmental levels.
    1. Hosting a focus group on perceptions of health within the community.
    2. Teaching a client how to self-administer insulin.
    3. Doing a complex dressing change on a client’s leg.
    4. Conducting a well-baby examination on a newborn.
    1. Primary
    2. Secondary
    3. Tertiary
    4. Secondary and tertiary
    5. Primary and tertiary
    1. They actively identify and reach out to anyone who may benefit from their services.
    2. They optimize available resources.
    3. They see the community as their client.
    4. They primarily focus on disease management.

    Author of lecture Introduction to Public Health Nursing

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN


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