1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 09 Population-Based Public Health Nursing Practice: The Intervention Wheel

2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Identify the components of the Intervention Wheel. 2. Describe the assumptions underlying the Intervention Wheel. 3. Define the wedges and interventions of the Intervention Wheel. 4. Differentiate among three levels of practice (community, systems, and individual/family). 5. Apply the nursing process at three levels of practice.

3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. The Intervention Wheel Origins and Evolution  Original version resulted from a grounded theory process carried out by public health nurse consultants at the Minnesota Department of Health in the mid-1990s  The consultant group presented a series of workshops across the state highlighting the core functions of public health nursing practice Workshop activity required participants to describe the actions they undertook to carry out their work  Adoption of the model was rapid and worldwide

4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumptions Underlying the Intervention Wheel Assumptions 1 through 10

5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 1: Defining PHN Practice  Public health nursing (PHN) is defined as the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences.  The title “PHN” designates a registered nurse with educational preparation in both public health and nursing.  The primary focus is to promote health and prevent disease for entire population groups.

6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 2: PHN Practice Focuses on Populations  The focus on populations as opposed to individuals is a key characteristic that differentiates public health nursing from other areas of nursing practice.  Population  Population at risk  Population of interest

7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 3: PHN Practice Considers the Determinants of Health  Health inequities  Significant health disparities related to race, gender, age, and socio-economic status exist within the United States  Determinants of health

8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 4: PHN Practice Is Guided by Priorities Identified Through an Assessment of Community Health  Assessment requires on-going collection and analysis of relevant quantitative and qualitative data  Assessment generally results in a lengthy list of community problems and issues  Identify gaps between needs and services

9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 5: PHN Practice Emphasizes Prevention  Prevention  Levels of prevention  A hallmark of PHN practice is a focus on health promotion and disease prevention, emphasizing primary prevention whenever possible.  Although not every event is preventable, every event has a preventable component.

10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 6: PHNs Intervene at All Levels of Practice  To improve population health, the work of PHNs is often carried out sequentially and/or simultaneously at three levels of prevention:  Community-level practice  Systems-level practice  Individual-level practice

11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 7: PHN Practice Uses the Nursing Process at All Levels of Practice  Although the components of the nursing process (assessment, diagnosis, planning, implementation, and evaluation) are integral to all nursing practice, PHNs must customize the process to the three levels of practice.

12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 8: PHN Practice Uses a Common Set of Interventions Regardless of Practice Setting  The Intervention Wheel encompasses 17 interventions.  The interventions are grouped with related interventions; these wedges are color coordinated to make them more recognizable.  The red, green, and blue wedges are mostly used by nurses focused on individuals, families, classes, and groups.  The orange and yellow wedges are mostly used by nurses focused on effecting systems and communities.

13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 9: PHN Practice Contributes to the Achievement of the 10 Essential Services  Interventions are the means through which PHNs implement the 10 essential services

14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Assumption 10: PHN Practice Is Grounded in a Set of Values and Beliefs  Cornerstones of PHN  The Intervention Wheel defines the “what and how” of PHN practice; the Cornerstones define the “why.”  The Cornerstones synthesize foundational values and beliefs from both public health and nursing.

15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Using the Intervention Wheel in PHN Practice  The Intervention Wheel is a conceptual model for PHN practice.  The Intervention Wheel provides a framework, a way of thinking about PHN practice.

16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. The Intervention Wheel Components

17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Components of the Intervetion Wheel Components 1 through 3

18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Component 1: The Model Is Population-Based  The upper portion of the Intervention Wheel illustrates that all levels of practice (community, systems, and individual/family) are population-based.  PHN practice identifies populations of interest or populations at risk through an assessment of community health status and an assignment of priorities.

19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Component 2: The Model Encompasses Three Levels of Practice  Levels of Practice:  Community-level  Systems-level  Individual/family-level  Interventions at each level of practice contribute to the overall goal of improving population health.  The work of PHNs is accomplished at all levels.

20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Component 3: The Model Identifies and Defines 17 Public Health Interventions  Surveillance  Disease and other health investigation  Outreach  Screening  Case finding  Referral and follow-up  Case management  Delegated functions  Health teaching  Consultation  Counseling  Collaboration  Coalition building  Community organizing  Advocacy  Social marketing  Policy development and enforcement

21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Applying the Nursing Process at the Individual/Family Level  Community assessment  Assessment of a family  Diagnosis  Planning (Including selection of interventions)  Implementation  Collaboration  Case management  Health teaching  Delegated functions (PHN to paraprofessional)  Referral and follow-up  Evaluation

22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Applying the PHN Process at the Community Level of Practice Scenario  Community assessment (PHN process: assessment)  Community diagnosis (PHN process: diagnosis)  Community action plan (PHN process: planning, including selection of interventions)  Menu changes  Classroom activities  Family involvement  Community implementation plan (PHN process: implementation)  Community evaluation (PHN process: evaluation)

23 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Applying the PHN Process to a Systems Level of Practice Scenario  Assessment  Diagnosis  Planning (Including selection of interventions)  Implementation  Consultation  Referral and follow-up  Advocacy  Policy development  Surveillance  Evaluation