1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal 0-7668-2508-6

2. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company 2 Chapter 5: Population-Based Health Care Practice

3. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Upon completion of this chapter, the reader should be able to: Discuss the social mandate to provide population-based health care at the global, national, state, and local levels. Describe how population-based nursing is practiced within the community and the health care system. Identify vulnerable and high-risk population groups for whom specific health promotion and disease prevention services are indicated. Outline a multidisciplinary population-based planning and evaluation process that includes partnerships with the community and health care consumers.

4. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company4 Population-based Health Care Practice  Population-based health care practice is the development, provision, and evaluation of multidisciplinary health care services to population groups experiencing increased health care risks or disparities.  It involves partnership with health care consumers and the community in order to improve the health of the community and its population groups.

5. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company5 Population-based Health Care Practice  Vulnerable population groups are subgroups of a community that are powerless, marginalized, or disenfranchised and are experiencing health disparities.

6. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company6 Population-based Health Care Practice  Health risk factors are variables that increase or decrease the probability of illness or death.  Health determinants are variables that include biological, psychosocial, environmental (physical and social), and health systems factors or etiologies that may cause changes in the health status of individuals, families, groups, populations, and communities.

7. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company7 Population-based Health Care Practice  Health status is the level of health of an individual, family, group, population, or community.  Quality of life is the level of satisfaction one has with the actual conditions of one’s life.  Health-related quality of life refers to one’s level of satisfaction with those aspects of life that are influenced by one’s health status and health risk factors.

8. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company8 Population-based Health Care Practice  Functional health status is the ability to care for oneself and meet one’s human needs.  Activities of daily life are activities related to toileting, bathing, grooming, dressing, feeding, mobility, and verbal and written personal communication.

9. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company9 Population-based Health Care Practice  Instrumental activities of daily living (IADLs) are activities related to food preparation and shopping; cleaning; laundry; home maintenance; verbal, written, and electronic community communication; financial management; and transportation, as well as activities to meet social and support needs, manage health care needs, access community services and resources, and meet spiritual needs.

10. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company10 Population-based Health Care Initiatives  Health for All by the Year 2000 (World Health Organization)  Cairo Action Plan for Women’s Health (United Nations)  Healthy People 2010 (United States)  Tobacco Education and Prevention Program (Arizona)  Community-oriented Primary Care Model (Arkansas)  New Hampshire Coalition Against Domestic and Sexual Violence (New Hampshire)  Roll Up Your Sleeves (New Mexico)  Tenncare (Tennessee)

11. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company11 Population-focused Nursing Practice  Assess health of community as a whole  Develop nursing diagnosis  Identify populations needing health care services  Identify types of services needed

12. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company12 Population-based Nursing Practice  Emphasis on improving health status of vulnerable or at-risk populations within a community  Emphasis on health promotion and disease prevention interventions

13. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company13 Population-based Nursing Practice Model  Population-based interventions encompass three levels: Community Systems within the community Individuals, families, and groups

14. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company14 Nontraditional Model of Population- based Nursing Practice  Vulnerable or at-risk populations are identified before community assessment.  Subsequent community assessment focuses on health determinants related to the at-risk groups.  Traditional model assesses overall community needs first, and at-risk population needs second.

15. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company15 Nursing Process Applied to Population- based Nursing Practice  Assessment  Diagnosis  Planning and implementation  Evaluation

16. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company16 Assessment  Community level Physical environment Social environment Policies and interventions  Health systems level Access to quality health care Behavioral Data analysis

17. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company17 Diagnosis  Identify North American Nursing Diagnosis Association (NANDA) category.  Identify etiology and list key evidence supporting diagnostic category.

18. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company18 Planning and Implementation  Select and employ population-based nursing intervention model.  Examples of population-based nursing intervention models: Minnesota Model Virginia Model

19. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company19 Evaluation  Collect data.  Develop statistics.  Share results with multidisciplinary teams, health consumers, and community partnerships.  Identify unmet needs and further interventions.

20. Chapter 1Copyright © 2003 Delmar Learning, a Thomson Learning company20 Program Evaluation  Integral part of population-based health care evaluation process  Provides justification of resources and budget  Factors to evaluate: Access Quality Cost Equity