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Chapter 7 Chapter 7
Population-Based Health Care Practice
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ObjectivesObjectives
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
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ObjectivesObjectives
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
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Population-Based Population-Based Health Care PracticeHealth Care Practice
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
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Population-Based Population-Based Health Care PracticeHealth Care Practice
Vulnerable population groups Subgroups of a community that are powerless, marginalized, and disenfranchised and are experiencing health disparities
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Population-Based Population-Based Health Care PracticeHealth Care Practice
Health risk factors are variables that increase or decrease the probability of illness or death
Health determinants are variables that may cause changes in the health status of individuals or groups and include: Biological factors Psychosocial factors Environmental factors (physical and social) Health systems factors or etiologies
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Goals of Population-Goals of Population-Based Health CareBased Health Care
Improvement of access to health care services
Improvement of quality of health care services
Reduction of health disparities among different population groups
Reduction of health care delivery costs
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Outcomes MeasurementOutcomes Measurement
Population health status Quality of life Functional health status
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Health StatusHealth Status
Health status The level of health of an individual, family, group, population, or community
Quality of life 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
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Functional Health Functional Health StatusStatus
Functional health status The ability to care for oneself and meet one’s human needs
Activities of daily life Activities related to toileting, bathing, grooming, dressing, feeding, mobility, and verbal and written personal communication
Instrumental activities of daily living Related to home management, financial management, seeking health care, and meeting spiritual needs
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Health Determinant Health Determinant ModelsModels
Provide conceptual tools to use in assessing and addressing the priority health needs of at-risk population groups
Healthy People 2010 emphasizes four key elements to achieve health improvement Goals Objectives Determinants of health Health status
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Health DisparitiesHealth Disparities
Differences in health risks and health status measures that reflect the poorer health status that is found disproportionately in certain population groups
Leads to unequal burdens in disease morbidity and mortality rates borne by racial and ethnic groups in comparison to the dominant racial or ethnic group in society
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Health Care Systems Health Care Systems DisparitiesDisparities
Differences in health care system access and quality of care for different racial, ethnic, and socioeconomic population groups that persist across settings, clinical areas, age, gender, geography, and health needs and disabilities
Result in poorer health care outcomes
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Major Health Major Health IndicatorsIndicators
Physical activity
Overweight/obesity
Tobacco use Substance abuse Responsible sexual behavior
Mental health Injury and violence
Environmental quality
Immunizations and access to health care
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Culturally Inclusive Culturally Inclusive Health CareHealth Care
U.S. population is becoming more diverse Ethnic minorities in the United States who have been marginalized from mainstream society experience more health care disparities and increased rates of morbidity, mortality, and burden of disease
The proportion of ethnic minorities in the registered nurse workforce in 2004 continues to lag behind the proportion of ethnic minorities in the U.S. population
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Barriers in the Barriers in the WorkplaceWorkplace
Lack of awareness of differences
Lack of time Ethnocentrism Bias and prejudice Lack of skills to address differences
Lack of organizational support
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Culturally Inclusive Culturally Inclusive Health Care SystemHealth Care System
One in which health care is population based
Requires significant change in the current health care system
Will require increased diversity in the health care workforce
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Population-Focused Population-Focused Nursing PracticeNursing Practice
Nursing activities that focus on all of the people and reflect responsibility to and for the people
Focus is on: Maximizing health status Maximizing functional abilities Improving the quality of life of groups of health care consumers
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Population-Based Population-Based Nursing PracticeNursing Practice
The practice of nursing in which the focus of care is to improve the health status of vulnerable or at-risk population groups within the community by employing health promotion and disease prevention interventions across the health continuum
Holistic in nature Seeks to empower population groups by enhancing their protective factors and resiliency
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Protective FactorsProtective Factors
Client strengths and resources are used to combat health threats that compromise core human functions
Resilience The social and psychosocial capacity of individuals and groups to adapt, succeed, and persevere over time in face of recurring threats to psychosocial and physiologic integrity
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Population-Based Population-Based Nursing Practice ModelNursing Practice Model Population-based interventions encompass three levels: Community Systems within the community Individuals, families, and groups
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Population-Based Population-Based Nursing Practice Nursing Practice InterventionsInterventions
Initiate a community health assessment
Provide nursing interventions in a culturally sensitive and appropriate manner
Apply the nursing process in working with communities, organizations, and population groups
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Nontraditional Model of Nontraditional Model of Population-Based Nursing Population-Based Nursing
PracticePractice 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
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Nursing Process Applied Nursing Process Applied to Population-Based to Population-Based Nursing PracticeNursing Practice
Assessment Diagnosis Planning and implementation Evaluation
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AssessmentAssessment
Community level Physical environment Social environment Policies and interventions
Health systems level Access to quality health care Behavioral Data analysis
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DiagnosisDiagnosis
Identify North American Nursing Diagnosis Association (NANDA) category
Identify etiology and list key evidence supporting diagnostic category
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Planning and Planning and ImplementationImplementation
Select and employ population-based nursing intervention model
Examples of population-based nursing intervention models: Minnesota model Virginia model
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EvaluationEvaluation
Program evaluation is integral part of evaluation process
Justification of resources and budget is necessary
Cost benefit analysis is appropriate Evaluate access, quality, cost, and equity Collect data and develop statistics Share results with multidisciplinary teams, health consumers, and community partnerships
Identify unmet needs and further interventions