1. Chapter 30 Public Settings for Community Health Nursing

2. 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

4. 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)

5. 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

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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

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

15. 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

16. 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

17. 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)

18. 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

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

20. 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

21. 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

22. 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.

23. 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

24. Internet Resources Indian Health Services: www.ihs.gov
Public Health Services/Commissioned Corps: commcorps.shs.net/default.aspx
National Association of School Nurses (NASN):
American Correctional Health Services Association (ACHSA):
American Nurses Association: Corrections Nursing/Scope & Standards of Practice: num=15