Chapter 30 Public Settings for Community Health Nursing

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): 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?cnum=15