Chapter 09 Population-Based Public Health Nursing Practice: The Intervention Wheel

1. Chapter 09Population-Based Public Health Nursing Practice: The Intervention Wheel

2. Objectives Identify the components of the Intervention Wheel. Describe the assumptions underlying the Intervention Wheel. Define the wedges and interventions of the Intervention Wheel. Differentiate among three levels of practice (community, systems, and individual/family). Apply the nursing process at three levels of practice.

3. The Intervention Wheel Origins and Evolution Original version resulted from a grounded theory process carried out by public health nurse consultants at the Minnesota Department of Health in the mid-1990s The consultant group presented a series of workshops across the state highlighting the core functions of public health nursing practice Workshop activity required participants to describe the actions they undertook to carry out their work Adoption of the model was rapid and worldwide

4. Assumptions Underlying the Intervention Wheel Assumptions 1 through 10

5. Assumption 1: Defining PHN Practice Public health nursing (PHN) is defined as the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. The title “PHN” designates a registered nurse with educational preparation in both public health and nursing. The primary focus is to promote health and prevent disease for entire population groups.

6. Assumption 2: PHN Practice Focuses on Populations The focus on populations as opposed to individuals is a key characteristic that differentiates public health nursing from other areas of nursing practice. Population Population at risk Population of interest

7. Assumption 3: PHN Practice Considers the Determinants of Health Health inequities Significant health disparities related to race, gender, age, and socio-economic status exist within the United States Determinants of health

8. Assumption 4: PHN Practice Is Guided by Priorities Identified Through an Assessment of Community Health Assessment requires on-going collection and analysis of relevant quantitative and qualitative data Assessment generally results in a lengthy list of community problems and issues Identify gaps between needs and services

9. Assumption 5: PHN Practice Emphasizes Prevention Prevention Levels of prevention A hallmark of PHN practice is a focus on health promotion and disease prevention, emphasizing primary prevention whenever possible. Although not every event is preventable, every event has a preventable component.

10. Assumption 6: PHNs Intervene at All Levels of Practice To improve population health, the work of PHNs is often carried out sequentially and/or simultaneously at three levels of prevention: Community-level practice Systems-level practice Individual-level practice

11. Assumption 7: PHN Practice Uses the Nursing Process at All Levels of Practice Although the components of the nursing process (assessment, diagnosis, planning, implementation, and evaluation) are integral to all nursing practice, PHNs must customize the process to the three levels of practice.

12. Assumption 8: PHN Practice Uses a Common Set of Interventions Regardless of Practice Setting The Intervention Wheel encompasses 17 interventions. The interventions are grouped with related interventions; these wedges are color coordinated to make them more recognizable. The red, green, and blue wedges are mostly used by nurses focused on individuals, families, classes, and groups. The orange and yellow wedges are mostly used by nurses focused on effecting systems and communities.

13. Assumption 9: PHN Practice Contributes to the Achievement of the 10 Essential Services Interventions are the means through which PHNs implement the 10 essential services

14. Assumption 10: PHN Practice Is Grounded in a Set of Values and Beliefs Cornerstones of PHN The Intervention Wheel defines the “what and how” of PHN practice; the Cornerstones define the “why.” The Cornerstones synthesize foundational values and beliefs from both public health and nursing.

15. Using the Intervention Wheel in PHN Practice The Intervention Wheel is a conceptual model for PHN practice. The Intervention Wheel provides a framework, a way of thinking about PHN practice.

16. The Intervention Wheel Components

17. Components of the Intervetion Wheel Components 1 through 3

18. Component 1: The Model Is Population-Based The upper portion of the Intervention Wheel illustrates that all levels of practice (community, systems, and individual/family) are population-based. PHN practice identifies populations of interest or populations at risk through an assessment of community health status and an assignment of priorities.

19. Component 2: The Model Encompasses Three Levels of Practice Levels of Practice: Community-level Systems-level Individual/family-level Interventions at each level of practice contribute to the overall goal of improving population health. The work of PHNs is accomplished at all levels.

20. Component 3: The Model Identifies and Defines 17 Public Health Interventions Surveillance Disease and other health investigation Outreach Screening Case finding Referral and follow-up Case management Delegated functions Health teaching Consultation Counseling Collaboration Coalition building Community organizing Advocacy Social marketing Policy development and enforcement

21. Applying the Nursing Process at the Individual/Family Level Community assessment Assessment of a family Diagnosis Planning (Including selection of interventions) Implementation Collaboration Case management Health teaching Delegated functions (PHN to paraprofessional) Referral and follow-up Evaluation

22. Applying the PHN Process at the Community Level of Practice Scenario Community assessment (PHN process: assessment) Community diagnosis (PHN process: diagnosis) Community action plan (PHN process: planning, including selection of interventions) Menu changes Classroom activities Family involvement Community implementation plan (PHN process: implementation) Community evaluation (PHN process: evaluation)

23. Applying the PHN Process to a Systems Level of Practice Scenario Assessment Diagnosis Planning (Including selection of interventions) Implementation Consultation Referral and follow-up Advocacy Policy development Surveillance Evaluation