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Faculty NotesNSG/485 Version 2Public Health: Health Promotion and Disease Prevention

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Faculty NotesNSG/485 Version 2 2

Table of ContentsCourse Revision History........................................................................................................................... 3Course Overview...................................................................................................................................... 4

Course Description............................................................................................................................... 4Course Information............................................................................................................................... 4Objectives and Topics.......................................................................................................................... 4

Week 1: Overview of Public and Community Health................................................................................6Curriculum Design Notes...................................................................................................................... 6Key Concepts....................................................................................................................................... 6Discussion Questions........................................................................................................................... 8

Week 2: Health Policy, Politics, and Health.............................................................................................9Curriculum Design Notes...................................................................................................................... 9Faculty Resources................................................................................................................................ 9Key Concepts....................................................................................................................................... 9Discussion Questions.........................................................................................................................11

Week 3: Epidemiology........................................................................................................................... 12Curriculum Design Notes....................................................................................................................12Faculty Resources.............................................................................................................................. 12Key Concepts..................................................................................................................................... 12Discussion Questions.........................................................................................................................13

Week 4: Public/Community Health Planning..........................................................................................14Curriculum Design Notes....................................................................................................................14Faculty Resources.............................................................................................................................. 14Key Concepts..................................................................................................................................... 14Discussion Questions.........................................................................................................................15

Week 5: Infectious and Communicable Disease Control.......................................................................16Curriculum Design Notes....................................................................................................................16Faculty Resources.............................................................................................................................. 16Key Concepts..................................................................................................................................... 16Discussion Questions.........................................................................................................................18

Week 6: Global Health........................................................................................................................... 19Curriculum Design Notes....................................................................................................................19Faculty Resources.............................................................................................................................. 19Key Concepts..................................................................................................................................... 19Discussion Questions.........................................................................................................................20

Week 7: Financing Public Health...........................................................................................................21Curriculum Design Notes....................................................................................................................21Faculty Resources.............................................................................................................................. 21Key Concepts..................................................................................................................................... 21Discussion Questions.........................................................................................................................22


Course Revision History

Revision Revision DetailsR1 Original course

R2 changed textbook, aligned content better for public health nursing, clarified language with regard to practice learning activities vs. clinical hours


Course Overview

Course Description

This course explores public and global health issues relevant to professional nursing practice. Topics include social responsibility and determinants of health, epidemiology, disease prevention and health promotion for at-risk populations, and national and global health organizations. A key focus is the application of evidence-based public health principles.

Course Information

Practice Learning Assignments ExplanationIn an effort to clarify language, this course now contains practice learning objectives and assignments rather than clinical objectives and clinical activities. Because this program does not contain direct interaction with patients, there are no clinical objectives. Practice learning assignments are designed to apply course content in a practice context.

Objectives and Topics

Course ObjectivesObjective 1.1: Evaluate the nurse’s role in public health. Objective 1.2: Analyze the relationship between the health policy, politics, and health.Objective 1.3: Analyze emerging global health issues that affect public health nursing. Objective 1.4: Apply epidemiological models and processes to promote public health. Objective 1.5: Analyze the nurse’s role in communicable disease control.

Practice Learning ObjectivesObjective 1.6: Utilize health promotion techniques to manage communicable disease in populations

Agencies and resources include but are not limited to: homeless shelters, child care facilities, schools, churches, community organizations, senior centers, jails, prisons, mental health facilities, National Council on Aging, and Community Clinics.

Objective 1.7: Develop plans to reduce morbidity and mortality in populations.

Agencies and resources include, but are not limited to: State Health Department, County Health Department, Visiting Nurses Association, regional Red Cross, State Department of Agriculture, Alcohol & Drug Addiction Services, Diabetes Association, American Cancer Society, Society, March of Dimes, Planned Parenthood, American Heart Association, and Food and Drug Administration.

Objective 1.8: Appraise public health programs at a national, state, and community level that influence health.

Agencies and resources include, but are not limited to: recreation centers, immunization clinics, clinics, health fairs, health departments, parks and recreation, school lunch programs, food donation, senior centers, flu clinics, mental health programs, free dental clinics, public transportation, emergency services, and health care delivery.


Week 1 Topic: Overview of Public and Community Health

Week 2 Topic: Health Policy, Politics, and Health

Week 3 Topic: Epidemiology

Week 4 Topic: Public/Community Health Planning

Week 5 Topic: Infectious and Communicable Disease Control

Week 6 Topic: Global Health

Week 7 Topic: Financing of Public Health


Week 1: Overview of Public and Community Health

Curriculum Design Notes

This week introduces students to public and community health nursing. The differences from a historical perspective in community and public health nursing are illustrated, but the textbook uses these terms interchangeably. The Public Health and Community/Family Health courses will share some concepts (e.g., health promotion), but will view them from different lenses; therefore, there will be some intentional overlap in content within the two courses. Current issues continue to include communicable disease concerns, environmental concerns, societal issues, and the cost of health care.

Key Concepts

Key Concept 1: Community/public health nursing Synthesis of nursing practice and public health practice Goal: preserve health of community and surrounding populations with focus on health promotion

and health maintenance of individuals, families, and groups within the community Mission of public health: social justice – all people are entitled to basic necessities (e.g., adequate

income, health protection) and accept the collective burden to make it possible (society responsible to meet basic needs of the people)

Public health nurses and social responsibility to promote social reform (Code of Ethics of ANA)

Key Concept 2: Definitions Health (World Health Organization) Community Determinants of Health Health Indicators Public Health Community Health Public health nursing Community health nursing

Key Concept 3: Differences between public health and community health Public health – science of health promotion, care, and preventative strategies for healthy

populations Community health focuses on the health care of individuals and families within their community or

immediate environment See Box 1-2 in textbook – Essential Public Health Services list

Key Concept 4: Core public health functions (per Institute of Medicine) – see Box 1-1 Assessment Policy development Assurance

Key Concept 5: Essential Public Health Services – See Box 1-2 Monitor health status to identify and solve community health problems Diagnose and investigate health problems and health hazards in community Inform, educate, and empower people about health issues Mobilize community partnerships and actions to identify and solve health problems Develop policies and plans that support individual and community health efforts


Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and assure provision of health care when otherwise

unavailable Assure competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solutions to health problems

Key Concept 6: Health Promotion and Disease Prevention Health promotion activities – improving wellbeing Disease prevention activities – protect people from disease and effects of disease Levels of prevention

o Primary preventiono Secondary preventiono Tertiary prevention

Review examples of levels of prevention and clients served in the community (see Table 1-1) Traditional focus of commercial healthcare insurance vs. managed care organizations Healthy People 2020 – initiative focused on health promotion and disease prevention

o Initiated in 2000o Two broad goals: (1) increase quality and years of healthy life; (2) eliminate health

disparities.

Key Concept 7: Definitions and focus of public health nursing, community health nursing and community-based nursing

Textbook authors use terms” community health nursing” and “public health nursing” interchangeably

Historical debates around delineating the differences between the two.o Classic definition of public health nursing related to it being a subspecialty nursing

practice generally delivered within an “official” or governmental agencyo Classic definition of community health nursing – broader/more general specialty area

encompassing multiple sub specialties (e.g., school, occupational health, home health) ANA definition (using American Public Health Association Committee on Public Health Nursing

definition) of public health nursing: “the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences.”

o Practice is population-focused; goals of promoting health and preventing disease and disability for all people through creation of conditions in which people can be healthy

Community-based nursing: application of nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system

o Setting-specific; emphasis on acute and chronic care; includes practice areas such as home health and outpatient or ambulatory settings

Quad Council of Public Health Nursing Organizations developed public health nursing competencies based on the core public health functions

Key Concept 8: Public Health Nurse Interventions – the Intervention Wheel The Public Health Intervention Wheel - developed in late 1990s by nurses from Minnesota

Department of Health Revised and renamed the Intervention Wheel Framework for community and public health nursing practice Three elements

o Population-based o Contains three levels of practice (community, systems, individual/family)o Identifies and defines 17 public health interventions

Wheel dissected into levels of practice; interventions may be directed at an entire population within a community, system that would affect the health of a population, and/or the individuals and families within the population


Key Concept 9: Community Health Nursing in Context: Historical Review Organized community health efforts have existed since prerecorded historic times (use of voodoo,

isolation, fumigation) The stages in disease history of humankind include the hunting and gathering stage, settled

villages stage, preindustrial cities stage, industrial cities stage, and present stage. The nineteenth century saw an increased awareness of the relationship between unsanitary living

conditions and communicable disease and shorter life spans. Health reform led to improved conditions; however, poorer segments of society continued to suffer

disproportionately. Public health nursing and community health nursing evolved from home nursing practice, community organizations, and political interventions on behalf of aggregates. Increased food production and better nutrition during 19th and early 20th centuries contributed to

decline in infectious disease-related deaths. Other factors: better sanitation through water purification, sewage disposal, improved food handling, and mild pasteurization.

With improvements in disease control, chronic disease became greatest threat to aggregate health. Community health increasingly affected by the tendency throughout history of people and groups to

live in increasingly closer proximity to one another. Increased interaction has resulted in increases in communicable disease outbreaks and epidemics.

Increases in industrialization and certain technologies have resulted in development of environmental pollution, particularly of air and water.

Nursing pioneers such as Nightingale and Wald in US focused on health care reforms, home nursing, community empowerment, and nursing education. They established the groundwork for today’s community health nursing.

Key Concept 10: 20th century – 10 great public health achievements in US (See Box 2-6) Vaccination/vaccine-preventable diseases Motor vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease (CHD) and stroke Safe and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Tobacco control

Key Concept 11: Current issues continue to include communicable disease concerns, environmental concerns, societal issues, and the cost of health care.

Discussion Questions

1. Describe the similarities and differences between a clinical nursing role and the population-based role of the public health nursing specialist.

2. Describe Nightingale’s contributions to public health, and community/public health nursing.


Week 2: Health Policy, Politics, and Health


Healthcare reform is changing the focus of healthcare in the United States. We are moving from a disease-oriented system to a health-oriented system. Healthcare funding is also transitioning to a value-based pricing structure. Public policy must address societal and environmental changes, in addition to lifestyle changes, that will positively influence health of entire population. Community/public health nurses have a responsibility to become advocates at a local, state and national level.

Faculty Resources

National Vaccine Information Center http://www.nvic.org/vaccine-laws.aspx

Ryan White program http://hab.hrsa.gov/ - Ryan White Treatment Extension Act

Obesityhttp://stateofobesity.org/rates/

General laws and policieshttp://www.cdc.gov/phlp/

http://lawatlas.org/query?dataset=laws-regulating-administration-of-naloxone

Numbers by statehttps://www.cdc.gov/psr/index.html

Key Concepts

Key Concept 1: US Healthcare system transitioning from a disease-oriented system to a health-oriented system.

Vast majority of US health expenditures spent providing care for the sick; only $0.03 of every health care dollar directed toward preventative health activities.

US health indicators rate considerably below the health indicators of many other countries, in spite of high hospital and physician expenditures

Health status of Americans varies markedly based on geographic location and among groups (economically disadvantaged and many cultural and ethnic groups have poorer overall health compared to middle-class Caucasians)

Between 1980 and 2008, more than doubled number of nurses working in community health and ambulatory settings

Influence of the Patient Protection and Affordable Care Act (PPACA) Movement to value-based pricing: public has right to know information about the healthcare system;

public accountability encourages open reporting and sharing of data across institutions and organizations; focused on the outcomes and costs of healthcare. This information now driving how healthcare institutions and agencies are reimbursed.

Key Concept 2: Health Policy, Politics, Legislation Policy, politics, and legislation are the forces that determine the direction of health programs at

every level of government.

https://www.cdc.gov/psr/index.html

http://lawatlas.org/query?dataset=laws-regulating-administration-of-naloxone

http://www.cdc.gov/phlp/

http://stateofobesity.org/rates/

http://hab.hrsa.gov/

http://www.nvic.org/vaccine-laws.aspx

Faculty NotesNSG/485 Version 2

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Core functions of government in healthcareo Assess healthcare problemso Intervene by developing relevant healthcare policy that provides access to serviceso Ensure services delivered and outcomes are achieved

Role of government (federal, state, and local) in health careo Direct services o Financingo Policy settingo Public protection

Health Policy – product of continuous interactive processes in which interested professionals, citizens, institutions, industries, and other groups compete with one another for the attention of various branches of government.

Key Concept 3: Health Policy Considerations in Public/Community Health Predominant model is US is “market justice” (people entitled to what they get through their efforts) –

minimal focus on collection action and obligation Conflict between public health and market justice – impact on access to care (initial access and

ongoing coverage) o Common ethical issues in community and public health practice (ethical insights – box – p.8)

Current US policies advocate changes in personal behaviors to promote health; this lessens focus on collective behaviors necessary to change determinants of health (e.g., air/water pollution, workplace hazards, unequal access to healthcare)

Environmental regulationso Clean water acto Clean air acto Food protection acto Occupational safety and health acto Federal insecticide, fungicide and rodenticide acto Health care quality

Public policy must address societal and environmental changes, in addition to lifestyle changes, that will positively influence health of entire population

Critical health care issues: impact of managed care, delivery of quality health care, fraud and abuse, impact of information technology, consumerism and patients’ rights, coordination and access to health care, disparity in health care delivery, and health care reform.

Key Concept 4: Politics and Role of Community/Public Health Nursing Mission of public health: social justice – all people are entitled to basic necessities (e.g., adequate


Community/public health nurses have a professional responsibility to promote social reform (Code of Ethics of ANA)

Examples of ways in which nurses can affect health policy: campaigning for a candidate who shares similar viewpoints; acting as a lobbyist to influence policy makers; involvement in political action committees, professional associations and/or coalitions to help influence help policy

Key Concept 5: Organization of Public Health System Public health system concerned with the health of populations and the provision of a health

environment; composed of programs at the federal, state, and local levels of government Federal level: Department of Public Health State level: State Department of Health - great variance from state to state, largely depending on

the geographic size of the state and the population Department of Housing and Urban Development (HUD)

o Reduce lead poisoning o Safety and injury prevention in low-income housing


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o Services for the homeless Local level: public health agencies are responsible for direct health care delivery Private health care subsystem: care provided by nonprofit and for-profit sectors and personal care

physicians

Key Concept 6: Role of Community/Public Health Nurse in Influencing Private Healthcare Organizations From internal standpoint, hold important management positions in managed care organizations

(MCOs); support and use nursing research that demonstrates positive clinical and economic outcomes.

From external standpoint, participate in discussions regarding quality and managed care; monitor quality ratings of MCOs; build entrepreneurial practice to provide lower-cost services for underserved groups; work cooperatively with other health professions to influence MCOs to improve quality of care.

Key Concept 7: Politics and Role of Community/Public Health Nursing Mission of public health: social justice – all people are entitled to basic necessities (e.g., adequate


Community/public health nurses have a professional responsibility to promote social reform (Code of Ethics of ANA)

Partnerships with legislative bodies – nurses can have profound impact o Stay informed of current policy and laws that influence both the health of the community and

nursing practice o Nurses should advocate for policies that protect public health or offer solutions to community

problems Nurses’ Role in Health Policy

o Change agents – advocate for needed change at local,, state, or federal level o Lobbyists – persuade or influence legislators (individually or through professional

organizations)o Public Office – influence policy development through public service


1. Examine the status of health care reform implementation in your state. Has this been effective? How is reform impacting community health in your state?

2. Investigate the Health Care Reform Act form the points of view of the consumer, health care provider, and third-party payer and community health. How has it affected the concerns of each of these constituents?


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Week 3: Epidemiology


This week introduces students to the field of epidemiology, which the community/public health nurse uses to quantify the extent of health problems in the community and to determine interventions and their potential effectiveness.

Faculty Resources

American Planning Association - https://www.planning.org/research/publichealth/

State and Territorial Healthy People Plan: https://www.healthypeople.gov/2020/healthy-people-in-action/State-and-Territorial-Healthy-People-Plans

Community Health Status Indicators: http://wwwn.cdc.gov/CommunityHealth

Key Concepts

Key Concept 1: Epidemiology Definition – study of health-related trends in populations for purposes of disease prevention, health

maintenance, and health protection Components

o Prevalence o Incidence o Distribution patterns o Treatment of disease

Epidemiological methodso Analytical (how and why of disease patterns; cause and effect)o Descriptive (who, where, and when of disease patterns)

Epidemiological models o Epidemiological triangle (relationship between agent, host and environment)o Wheel model (considers multiplicity of host and environmental interactions)o Web of causation (another model that considers complexity of interactions between host and

environment)o Eco-social epidemiology (emphasizes role of evolving macro-level socio-environmental

factors (e.g., complex political and economic forces) along with microbiological processes, in understanding health and illness)

Epidemiological rates – used to interpret raw data and for comparisons between aggregates and communities o Expressed as proportions or fractions – help consider a count of an event relative to the size

of the population from which it’s extractedo Morbidity rates (rates of illness)

Incidence Prevalence

o Mortality rates Crude death rate Infant mortality rate

o Crude birth rate o Fertility rate

http://wwwn.cdc.gov/CommunityHealth

https://www.healthypeople.gov/2020/healthy-people-in-action/State-and-Territorial-Healthy-People-Plans

https://www.planning.org/research/publichealth/


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Epidemiological data sources Epidemiological process

insert point

Key Concept 2: Use of Epidemiology in Disease Prevention Central goal to describe disease patterns, identifying etiological factors in disease development,

and taking most effective preventative measures Preventative measures specific to natural history of disease (stage of disease progression) Primary prevention (before disease development)

o Relies on epidemiological information to indicate those behaviors that are protective, those that won’t contribute to increase in disease, those associated with increased risk)

o Health promotion activities (e.g., regular exercise)o Specific protection activities (e.g., immunizations)

Secondary prevention (after disease develops)o Measures designed to detect disease at its earliest state (screening, physical examinations)o Interventions providing for early treatment and cure of diseaseo Epidemiological data and clinical trials determining effective treatment crucial

Tertiary prevention (limitation of disability and rehabilitation) o Epidemiological studies examining risk factors affecting function and suggestion of optimal

strategies in care of patients with advanced disease (e.g., evidence-based practice) Study designs in epidemiology

o Cohort o Longitudinalo Case – control o Descriptive o Cross-sectionalo Retrospectiveo Prospectiveo Experimental

Screening Surveillance

o Healthy People 2020 addresses ongoing need to extend inclusiveness of data collection and timeliness of data release (timely use)

Key Concept 3: Use of Epidemiology in Community Assessment and Program Planning Epidemiology provides broad understanding of the spread, transmission, and incidence of disease

and injury – important components of community assessment and program planning Use of surveillance data to describe health status of local and national subgroups

o Use data to evaluate impact of programs on specific groups in communityo Compare data for one locale with those of relevant neighborhood area to gain perspective on

magnitude of local problem


1. Imagine that during a community health assessment, it is revealed that 30% of the population is overweight (including children). Discuss interventions to reduce this prevalence rate.

2. Select one chronic disease that is prevalent within your community. Identify primary, secondary, and tertiary prevention measures in relation to the disease.


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Week 4: Public/Community Health Planning


Last week, students were introduced to the field of epidemiology. Epidemiological information is useful in the development of community health plans. This week, students are introduced to community health planning (which includes assessment, planning, intervention, and evaluation) – familiar to students as the nursing process.

Faculty Resources

American Planning Association - https://www.planning.org/research/publichealth/

State and Territorial Healthy People Plan: https://www.healthypeople.gov/2020/healthy-people-in-action/State-and-Territorial-Healthy-People-Plans

Community Health Status Indicators: http://wwwn.cdc.gov/CommunityHealth

Key Concepts

Key Concept 1: Community Health Planning Model “Community as client” – focus of health care planning and intervention that is directed to groups,

aggregates, organizations, or communities instead of toward individuals and families Using health planning model, nurse can assess, diagnose, plan, intervene, and evaluate an actual

or potential health need of a group or aggregate Steps of health planning model insert

o Assessmento Planningo Interventiono Evaluation

In order to identify prevention level, nurse must consider whether goal: o To prevent disease or conditiono Detect disease or conditiono Prevent disease or condition from worsening o Prevent complications from developing

After identifying source of problem, nurse should determine appropriate system levels(s) for direction of interventiono Subsystemo Aggregate o Suprasystem (larger community)

Interventions o Teaching o Personal counselingo Policy changeo Community service developmento Collaboration with other disciplines or community agencies

insert point

Key Concept 2: Health Planning Models in Public Health (Population-based Planning)

http://wwwn.cdc.gov/CommunityHealth

https://www.healthypeople.gov/2020/healthy-people-in-action/State-and-Territorial-Healthy-People-Plans

https://www.planning.org/research/publichealth/


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PRECEDE-PROCEED model PATCH APEX-PH program MAPP Model

Key Concept 3: Health planning legislation heavily influenced by the politics of the administration in power at any given time

Certificate of Need Patient Protection and Affordable Care Act (PPACA) of 2010

o Creation of task forces on preventative services and community preventative serviceso Establishment of National Prevention, Health Promotion, and Public Health Councilo Creation of innovation center within Centers for Medicare and Medicaid Services o Development of national quality improvement strategy o Provision of billions of dollars for funding community health centers, school-based clinics and

National Health Service Corpso Establishment of Independent Payment Advisory Boardo Establishment of workforce advisory Committee


1. Find the health plan from your local or state health department plan. Does it include assessment data, analysis, written goals and objectives, plans, and so forth? Has the plan been implemented? Is evaluation data available?

2. You are working with US Veterans who have served in Iraq/Afghanistan. Refer to the US Department of Veteran’s Affairs website (http://www.va.gov/health) and identify a health issue you should consider in your assessment.

http://www.va.gov/health


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Week 5: Infectious and Communicable Disease Control


This week focuses on communicable diseases. Textbook introduction says it well: “Throughout history, epidemics have been responsible for the destruction of entire groups of people. Despite amazing advances in public health and health care, control of communicable diseases continues to be a major concern of health care providers. The emergence of new pathogens, the reemergence of old pathogens, and the appearance of drug-resistant pathogens are creating formidable challenges worldwide.” (p. 489)Control of communicable diseases is an important role in public health nursing.

Faculty Resources

National Notifiable Diseases Surveillance System: https://wwwn.cdc.gov/nndss/conditions/notifiable/2016/

Immunization Guidelines website: www.cdc.gov

California Confidential Morbidity Report: https://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph110a.pdf

Key Concepts

Key Concept 1: Control of communicable diseases is an important role in public health nursing Failure in US and elsewhere that success of infectious disease control is not equally distributed in

the general population o Differential distribution by income and ethnic groups

Marked improvement in control of infectious and communicable insert point Millions of deaths each year worldwide due to communicable diseases Three of the 38 Healthy People 2020 topics specific to infectious diseases

o Immunization and Infectious Diseases o Sexually Transmitted Diseaseso HIV o Objectives used to evaluate national prevention and control efforts; can guide local

prevention and control efforts

Key Concept 2: Principles of infection/infection disease occurrence Multi-causation Spectrum of infection Stages of infection Spectrum of disease occurrence

Key Concept 3: Chain of Transmission – six connected links Infectious agent Reservoir Portal of exit Mode of transmission Portal of entry Host susceptibility

Key Concept 4: Control of infectious disease – disrupt any link in chain of transmission Controlling the agent

https://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph110a.pdf

http://www.cdc.gov/

https://wwwn.cdc.gov/nndss/conditions/notifiable/2016/


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Eradicating nonhuman reservoirs Controlling human reservoirs Controlling portals of entry or exit Improving host resistance or immunity

o Types of immunity Natural immunity Acquired immunity Active immunity Passive immunity Herd immunity

Surveillance – community nursing roleo Purposeso Types o Statistical rates and surveillanceo State-specific reporting – example – California Confidential Morbidity Report o National Notifiable Diseases Surveillance System

Key Concept 5: Prevention of communicable diseases Primary prevention: measures to prevent transmission of infectious agent and to prevent pathology

in the person exposed to an infection Secondary prevention: includes activities for early detection and treatment of persons who are

infected Tertiary prevention: includes activities involved in caring for persons with an infectious disease to

ensure that they are cured or that their quality of life is maintained

Key Concept 6: Identification of at-risk populations Environmental exposure (air, water, food) Overcrowded conditions Access to services Injection drug use High-risk sexual behaviors

Key Concept 7: Outbreak Investigation Definition Sources of data for investigation Process

Key Concept 8: Immunization Community health nurse plays major role in increasing immunization coverage Often administered in community health settings (e.g., public health environments) Community health nurse roles/responsibilities

o Track immunization schedules for at-risk populationso Educate community about importance of immunizationso Maintain current knowledge – immunization schedules/appropriate precautions

Immunization guidelines: Barriers to immunization coverage

o Religiouso Financialo Social and culturalo Philosophicalo Provider limitations


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1. There has been a reemergence of vaccine preventable diseases in the United States. Why do you think this trend is occurring? How can a public health nurse increase vaccination rates in their community?

2. A trend of new cases of HIV has been discovered among those 55 and older in your community. What are some of the reasons this could potentially occur? Describe how a public health nurse could reduce the number of new cases.


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Week 6: Global Health


This week focuses on global health. Health care and health care reform are areas of worldwide focus. Health care access for all is one aspect of the global health agenda. Understanding global issues and trends will assist nurses in providing care while working in foreign countries or working domestically with patients from various countries.

Faculty Resources

Institute for Health Metrics and Evaluation: http://www.healthdata.org/gbd

Key Concepts

Key Concept 1: Trends in Global Health Globalization: increased social and economic dependence and integration as capital, goods,

person, concepts, images, ideas, and values cross state boundaries o Influence of technologyo Frequency of international travel

Population characteristics o Enormous population growth presents a threat to the health and economy of many nations. o World population distribution is uneveno As world population grows, global trend toward urbanization

Population health threatened by environmental factors and diseaseo

Environmental factorso Environmental stressorso Pollution

Air Water Land

o Patterns of health and disease

o Differences in developed and developing countries Disease patterns Primary causes of death Racial, ethnic and access disparities

o Developed countries Primary causes of mortality related to chronic diseases, violence, and traumatic injury

o Developing countries Infections, malnutrition and violence

o xo

Emerging pathogens o World Health Organization list of top emerging diseases likely to cause epidemics

http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en/ o List provides basis for WHO Blueprint for Research & Development preparedness o x

Multi-drug resistant organisms – see PBS Frontline specials

http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en/

http://www.healthdata.org/gbd


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Key Concept 2: Global Burden of Disease (GBD) Per Institute for Health Metrics and Evaluation: “(GBD) provides a tool to quantify health loss from

hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities can be eliminated.

Incorporates both prevalence of given disease or risk factor and relative harm it causes – assists in decision-making

Data can be used to understand health trends over time, just like gross domestic product data (GDP) used to monitor a country’s economic activity

Measurement: disability-adjusted-life-year (DALY). o Time-based measure combining years of life lost due to premature mortality and years of life

lost due to time lived in states of less than full health (http://www.who.int/topics/global_burden_of_disease/en/)

This time-based measure combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health.

Key Concept 3: International Agencies and Organizations World Health Organization (WHO)

o Provides daily information regarding the occurrence of internationally important diseases o Establishes world standards for antibiotics and vaccineso Primarily focuses on health care workforce and education, environment, sanitation, infectious

diseases, maternal and child health, primary care o 1978 - development of WHO Goal – “health for all by the year 2000”

Global Observatory Data International Council of Nurses United Nations

o Millennium Development Goals Pan American Health Organization (PAHO) Nongovernmental organizations (NGOs)

Key Concept 4: Role of Community Health Nursing in International Health Care (see PowerPoint inInstructor Resources)

Seek to ensure attainment of health for all in a cost-effective, efficient, accessible health care system

Be involved in research, community assessment, planning, implementation, management, evaluation, health services delivery, emergency response, health policy, and legislation

Coordinate work with other health care personnel and community leaders as well as local and global community leaders


1. Select an area outside of the United States to visit. Research the area. What types of community health risks are prevalent in the area (e.g. infectious diseases, crime)?

2. How can global health concerns affect local communities here in the United States?

http://www.who.int/topics/global_burden_of_disease/en/


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Week 7: Financing Public Health


This week focuses on global health. Health care and health care reform are areas of worldwide focus. Health care access for all is one aspect of the global health agenda. Understanding global issues and trends will assist nurses in providing care while working in foreign countries or working domestically with patients from various countries.

Faculty Resources

CDC website: http://www.cdc.gov/stltpublichealth/about/index.html

CDC Public Health Financing PowerPoint (attached)

Key Concepts

Key Concept 1: Review – healthcare funding Factors influencing the cost of health care include use of health care, lack of preventative care,

health behaviors and lifestyle choices, societal beliefs, technological advances, aging of society, pharmaceuticals, shift to for-profit health care.

Medicare provides health care to those 65 years of age and older; to persons with permanent disabilities, and to persons with end-stage renal disease.

Medicaid: health care coverage for children and low-income individuals Indemnity plans: those in which enrollees have free choice of the providers of services, and all

costs of covered services are paid. Health maintenance organizations: groups of providers formed by companies and insurers to

reduce costs by focusing on preventative care and coordinating care. Preferred provider organizations (networks): organizations of providers who deliver services to

enrollees of one insurance company through a negotiated discounted rate in exchange for a guaranteed increase in the number of consumers.

Most common reimbursement mechanisms of insurance plans: traditional fee-for-service model, prospective reimbursement, and capitated payment.

Grant funding: federal, state and philanthropic sources major source for funding prevention-oriented public health initiatives.

Key Concept 2: Federal Agencies related to Healthcare Funding US Department of Health & Human Services – under direction of Secretary of Health Administration of Children and Families (ACF) Administration for Community Living (ACL) Centers for Medicare and Medicaid (CMS)

Health Insurance Portability and Accountability Act (HIPAA) Supplemental Security Income (SSI) Medicare Medicaid

Centers for Disease Control and Prevention (CDC) Health Resources and Service Administration (HRSA) Indian Health Service (HIS) National Institute of Health (NIH) – includes National Institute for Nursing Research [NINR] Substance Abuse and Mental Health Services Administration (SAMHSA) Veterans Health Administration (within US Department of Veterans Affairs)

http://www.cdc.gov/stltpublichealth/about/index.html


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Key Concept 3: State Health Department

Manages the Women, Infants and Children (WIC) program Oversees Children’s Health Insurance Program (CHIP) Responsible for administration of Medicaid program

Key Concept 4: Local Health Department Funded through local taxes with support from state and federal funds Offers various services and programs Nurses typically function in roles of caregiver, advocate, teacher, coordinator, and consultant

Key Concept 5: Public Health Financing (see CDC Public Health Financing PowerPoint) Federal agency budgets – congress authorizes activities and appropriates funding State Health Agency – mixture of state and federal funds Federal grants and contracts

Most federal funding awarded via a competitive or merit-based process Some funding allocated according to pre-set formula (may be specified in law)

Some funding allocated according to pre-set formula (sometimes specified in law) Centers for Disease Control establishes grant funding by state Fees and third-party reimbursements Grants from private foundations Non-governmental organizations

Key Concept 6: Home Health Care Funding Private insurance Medicare – medical needs

Skilled nursing, therapy, some durable medical equipment Medicaid – non-medical needs


1. Search the internet for grant opportunities for public health. Select one funding opportunity. Which agency or organization is offering the grant? What are the requirements to apply?

2. After reading the WHO document, Health Systems Financing: The Path To Universal Coverage, discuss parallels between it and provisions in the Patient Protection and Affordable Care Act (2010).

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