Chapter 30 Public Settings for Community Health Nursing

Public Health Nursing Education: entry level, BSN; certification for PHN with master’s degree Key functions in public settings Health of populations; community needs and priorities Caring relationships (individuals, families, communities, and systems) Grounded in cultural sensitivity, compassion, social justice, and a belief in the worth of all people All aspects of health; strategies to promote health motivated by epidemiologic evidence Individual and collaborative, strategies to achieve results

Public Health Funding & Governmental Structures Dept. of Health & Human Services Health Resources and Services Administration (HRSA) Indian Health Services (IHS) CDC NIH FDA SAMHSA Agency for Toxic Substances and Disease Registry (ATSDR) Agency for Health Care Research and Quality (AHRQ)

State and Local Government State health departments carry forth regulations and policies determined by federal government such as Medicaid, Medicare, state children’s health insurance programs Local health departments carry out state laws and policies; provide the most direct, immediate care; work with state health departments

Question Is the following statement true or false? The CDC is a division of the Department of Health and Human Services.

Answer True The main federal agency is the Department of Health and Human Services, and the CDC is a division of this agency.

Nursing Roles Assess: community data, trends, epidemiology, population growth data for planning services, environmental risks Diagnose: identify priorities, apply information and observe changes, emergence of new issues Plan and implement: collaborative interventions, education, advocates to influence change Evaluate: programs and interventions, rates, research involvement

Public Health Nursing Careers Federal/state level: consultant roles, program leaders Involvement with Dept. of Veterans Affairs, DHHS, NIH, HRSA, FDA, SAMHSA, and CDC; Indian Health Services Non-civilian public health nursing: uniformed services such as Army, Navy, Marines, Air Force, Coast Guard, NOAA, U.S. Public Health Services Commissioned Corps

School Nursing Beginning in mid-1800s; Lina Rogers was first to work with families & schools in New York (1902) Specialty branch serving school-age population Students from birth through age 21 yrs, students’ families, and school community in regular & special education and other educational settings Expansion of role Key roles: liaison with interdisciplinary school health team; positive working relationship with administrators and teachers

Responsibilities of the School Nurse Prevent illness, promote & maintain health of school community Identify health-related barriers to learning Care of children with special health needs General and emergency first aid Vision, hearing, scoliosis, and TB screenings; height, weight, and blood pressure monitoring; oral health and dental education; immunization assessment and monitoring Medication administration; assessment of acute health problems Health examinations, referrals. Training staff in CPR, infection precautions, first aid Overseeing the health and wellness of school staff

Special Training and Skills of the School Nurse School system base: entire time spent at school Public health department base: portion of day at school; other responsibilities such as home or clinic visits RN with minimum of bachelor’s degree; frequently with additional education beyond bachelor’s degree, sometimes including master’s degree Possibly LPN or LVN under RN supervision in areas of the country School nurse practitioners: RNs with advanced preparation; usually certification and master’s degree in nursing

Question Is the following statement true or false? A school nurse needs a minimum of a master’s degree in nursing to practice in this role.

Answer False To be a school nurse, a minimum of a bachelor’s degree in nursing is required.

Functions of School Nursing Practice Health services for chronic conditions (individualized health plans [IHPs] for asthma, diabetes, seizures, food allergies; behavioral problems & learning disabilities; medication administration) Health services to prevent illness or injury: immunizations, safety measures Health education and health promotion: screenings Promotion of healthful school environment: nutrition, exercise, risk behaviors (sexual activity, substance abuse), mental health, abuse School-based health centers

School Nursing Careers Skills needed: Ability to work autonomously Excellent communication skills Ability to prioritize and collaborate Pay highly variable Monday through Friday work week, with holidays and summers off

History of Corrections Nursing Minimal if any health care to inmates 1976: Supreme Court ruling that not providing medical services inflicted pain and denied inmates of their Eighth Amendment rights Led to major reforms in corrections health system Correctional Medical Services: largest provider of prison health care in the nation Corrections nurses work in onsite medical units housed in criminal justice facilities (local jails, state or federal prisons)

Education and Functions of Corrections Nurses Education: bachelor’s degree preferred; some institutions may require additional coursework in criminal justice, decision making, assessment, and administrative skills; nurse practitioners (with master’s degree) provide primary health care Functions: restore & maintain health of inmates via a variety of skills; track and screen for communicable diseases; assist in setting up resources for continuing care after release; educate and promote healthy lifestyles; assist in assessing medical conditions; assist in medical emergencies

Common Health Concerns Facing Corrections Nurses Mental health issues Drug abuse Communicable diseases: HIV/AIDS, TB, hepatitis C

Future Trends Older, sicker inmates staying in prison longer Increasing population of female inmates Reproductive issues Higher rates of diabetes, HIV, STIs, mental illness, drug abuse, and emotional issues Increase in chronic diseases: diabetes, asthma, heart disease

Question Which of the following would a corrections nurse expect to face in the future? Younger, healthier inmates Decreased chronic illnesses More women inmates Shorter stays for inmates

Answer c. More women inmates Future trends include an increase in the population of female inmates; older, sicker inmates staying in prison for longer amounts of time; and an increase in chronic illnesses.

Corrections Nursing Careers Skills Good mental health and assessment skills Communication skills Strong nursing advocates Flexibility and knowledgeable Salaries depend on state; usually higher than in other nursing fields; extensive employee benefits and insurance packages

Internet Resources Indian Health Services: www.ihs.gov Public Health Services/Commissioned Corps: commcorps.shs.net/default.aspx National Association of School Nurses (NASN): www.nasn.org American Correctional Health Services Association (ACHSA): www.achsa.org American Nurses Association: Corrections Nursing/Scope & Standards of Practice:http://nursingworld.org/books/pdescr.cfm?c num=15