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  1. 1. Chapter 7 Population-Based Health Care Practice
  2. 2. Objectives <ul><li>Upon completion of this chapter, the reader should be able to:  </li></ul><ul><ul><li>Discuss the social mandate to provide population-based health care at the global, national, state, and local levels  </li></ul></ul><ul><ul><li>Describe how population-based nursing is practiced within the community and the health care system </li></ul></ul>
  3. 3. Objectives <ul><ul><li>Identify vulnerable and high-risk population groups for whom specific health promotion and disease prevention services are indicated </li></ul></ul><ul><ul><li>Outline a multidisciplinary population-based planning and evaluation process that includes partnerships with the community and health care consumers </li></ul></ul>
  4. 4. Population-Based Health Care Practice <ul><li>The development, provision, and evaluation of multidisciplinary health care services to population groups experiencing increased health care risks or disparities </li></ul><ul><li>It involves partnership with health care consumers and the community in order to improve the health of the community and its population groups </li></ul>
  5. 5. Population-Based Health Care Practice <ul><li>Vulnerable population groups </li></ul><ul><ul><li>Subgroups of a community that are powerless, marginalized, and disenfranchised and are experiencing health disparities </li></ul></ul>
  6. 6. Population-Based Health Care Practice <ul><li>Health risk factors are variables that increase or decrease the probability of illness or death </li></ul><ul><li>Health determinants are variables that may cause changes in the health status of individuals or groups and include: </li></ul><ul><ul><li>Biological factors </li></ul></ul><ul><ul><li>Psychosocial factors </li></ul></ul><ul><ul><li>Environmental factors (physical and social) </li></ul></ul><ul><ul><li>Health systems factors or etiologies </li></ul></ul>
  7. 7. Goals of Population-Based Health Care <ul><li>Improvement of access to health care services </li></ul><ul><li>Improvement of quality of health care services </li></ul><ul><li>Reduction of health disparities among different population groups </li></ul><ul><li>Reduction of health care delivery costs </li></ul>
  8. 8. Outcomes Measurement <ul><li>Population health status </li></ul><ul><li>Quality of life </li></ul><ul><li>Functional health status </li></ul>
  9. 9. Health Status <ul><li>Health status </li></ul><ul><ul><li>The level of health of an individual, family, group, population, or community </li></ul></ul><ul><li>Quality of life </li></ul><ul><ul><li>The level of satisfaction one has with the actual conditions of one’s life </li></ul></ul><ul><li>Health-related quality of life </li></ul><ul><ul><li>Refers to one’s level of satisfaction with those aspects of life that are influenced by one’s health status and health risk factors </li></ul></ul>
  10. 10. Functional Health Status <ul><li>Functional health status </li></ul><ul><ul><li>The ability to care for oneself and meet one’s human needs </li></ul></ul><ul><li>Activities of daily life </li></ul><ul><ul><li>Activities related to toileting, bathing, grooming, dressing, feeding, mobility, and verbal and written personal communication  </li></ul></ul><ul><li>Instrumental activities of daily living </li></ul><ul><ul><li>Related to home management, financial management, seeking health care, and meeting spiritual needs </li></ul></ul>
  11. 11. Health Determinant Models <ul><li>Provide conceptual tools to use in assessing and addressing the priority health needs of at-risk population groups </li></ul><ul><li>Healthy People 2010 emphasizes four key elements to achieve health improvement </li></ul><ul><ul><li>Goals </li></ul></ul><ul><ul><li>Objectives </li></ul></ul><ul><ul><li>Determinants of health </li></ul></ul><ul><ul><li>Health status </li></ul></ul>
  12. 12. Health Disparities <ul><li>Differences in health risks and health status measures that reflect the poorer health status that is found disproportionately in certain population groups </li></ul><ul><li>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 </li></ul>
  13. 13. Health Care Systems Disparities <ul><li>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 </li></ul><ul><li>Result in poorer health care outcomes </li></ul>
  14. 14. Major Health Indicators <ul><li>Physical activity </li></ul><ul><li>Overweight/obesity </li></ul><ul><li>Tobacco use </li></ul><ul><li>Substance abuse </li></ul><ul><li>Responsible sexual behavior </li></ul><ul><li>Mental health </li></ul><ul><li>Injury and violence </li></ul><ul><li>Environmental quality </li></ul><ul><li>Immunizations and access to health care </li></ul>
  15. 15. Culturally Inclusive Health Care <ul><li>U.S. population is becoming more diverse </li></ul><ul><li>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 </li></ul><ul><li>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 </li></ul>
  16. 16. Barriers in the Workplace <ul><li>Lack of awareness of differences </li></ul><ul><li>Lack of time </li></ul><ul><li>Ethnocentrism </li></ul><ul><li>Bias and prejudice </li></ul><ul><li>Lack of skills to address differences </li></ul><ul><li>Lack of organizational support </li></ul>
  17. 17. Culturally Inclusive Health Care System <ul><li>One in which health care is population based </li></ul><ul><li>Requires significant change in the current health care system </li></ul><ul><li>Will require increased diversity in the health care workforce </li></ul>
  18. 18. Population-Focused Nursing Practice <ul><li>Nursing activities that focus on all of the people and reflect responsibility to and for the people </li></ul><ul><li>Focus is on: </li></ul><ul><ul><li>Maximizing health status </li></ul></ul><ul><ul><li>Maximizing functional abilities </li></ul></ul><ul><ul><li>Improving the quality of life of groups of health care consumers </li></ul></ul>
  19. 19. Population-Based Nursing Practice <ul><li>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 </li></ul><ul><li>Holistic in nature </li></ul><ul><li>Seeks to empower population groups by enhancing their protective factors and resiliency </li></ul>
  20. 20. Protective Factors <ul><li>Client strengths and resources are used to combat health threats that compromise core human functions </li></ul><ul><li>Resilience </li></ul><ul><ul><li>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 </li></ul></ul>
  21. 21. Population-Based Nursing Practice Model <ul><li>Population-based interventions encompass three levels:  </li></ul><ul><ul><li>Community </li></ul></ul><ul><ul><li>Systems within the community </li></ul></ul><ul><ul><li>Individuals, families, and groups </li></ul></ul>
  22. 22. Population-Based Nursing Practice Interventions <ul><li>Initiate a community health assessment </li></ul><ul><li>Provide nursing interventions in a culturally sensitive and appropriate manner </li></ul><ul><li>Apply the nursing process in working with communities, organizations, and population groups </li></ul>
  23. 23. Nontraditional Model of Population-Based Nursing Practice <ul><li>Vulnerable or at-risk populations are identified before community assessment </li></ul><ul><li>Subsequent community assessment focuses on health determinants related to the at-risk groups </li></ul><ul><li>Traditional model assesses overall community needs first, and at-risk population needs second </li></ul>
  24. 24. Nursing Process Applied to Population-Based Nursing Practice <ul><li>Assessment </li></ul><ul><li>Diagnosis </li></ul><ul><li>Planning and implementation </li></ul><ul><li>Evaluation </li></ul>
  25. 25. Assessment <ul><li>Community level </li></ul><ul><ul><li>Physical environment </li></ul></ul><ul><ul><li>Social environment </li></ul></ul><ul><ul><li>Policies and interventions </li></ul></ul><ul><li>Health systems level </li></ul><ul><ul><li>Access to quality health care </li></ul></ul><ul><ul><li>Behavioral </li></ul></ul><ul><ul><li>Data analysis </li></ul></ul>
  26. 26. Diagnosis <ul><li>Identify North American Nursing Diagnosis Association (NANDA) category </li></ul><ul><li>Identify etiology and list key evidence supporting diagnostic category </li></ul>
  27. 27. Planning and Implementation <ul><li>Select and employ population-based nursing intervention model  </li></ul><ul><li>Examples of population-based nursing intervention models: </li></ul><ul><ul><li>Minnesota model </li></ul></ul><ul><ul><li>Virginia model </li></ul></ul>
  28. 28. Evaluation <ul><li>Program evaluation is integral part of evaluation process </li></ul><ul><li>Justification of resources and budget is necessary </li></ul><ul><li>Cost benefit analysis is appropriate </li></ul><ul><li>Evaluate access, quality, cost, and equity </li></ul><ul><li>Collect data and develop statistics </li></ul><ul><li>Share results with multidisciplinary teams, health consumers, and community partnerships </li></ul><ul><li>Identify unmet needs and further interventions </li></ul>