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Nursing role in public health and wellbeing
- 1. 900� British�Journal�of�Nursing,�2013,�Vol�22,�No�15 © �2 01 3� M A �H ea lth ca re �L td T he� challenges� to� the� NHS� over� the�coming�years�to�maintain�and�enhance�public� health� and� wellbeing� are� vast�and� complex.� Lifestyle� choices� and� the� causes� of� ill� health� are� now� more� fully� understood� by� health� professionals� who� have� strategies� at� their� disposal� to� support� people� better� in� making� decisions� and� choices� that� are� positive� for� their� general� health.� In� June� 2013,� to� help� accelerate� this� process,� Public�
- 2. Health�England�published�Nursing and Midwifery Contribution to Public Health� (Public� Health� England,�2013).�This�new�guidance�document� is� designed� to� illuminate� the� specific� roles� of� specialist� public� health� nurses,� but� also� to� reinforce� the� pivotal� health-promoting� practitioner� role� that� every� registered� nurse� and� midwife� has� in� making� every� patient/ client�contact�count. Background A� report� by� The� King’s� Fund� (2012)� has� shown�that�high�levels�of�admission�to�hospital,� especially� of� elderly� patients,� can� often� be� attributed� to� poor� coordination� between� the� different� elements� of� the� healthcare� system,� in�particular�between�primary� and� secondary� care.� Furthermore,� the� King’s� Fund� believe� that� emergency� admissions� among� people� with� long-term� conditions� that� could� have� been�managed�in�primary�care�cost�the�NHS� £1.42� billion� per� year,� a� figure� that� could� be� significantly� reduced� through� investment� in� primary� and� community-based� services.� Key� to� this� aspiration� is� promoting� the� role� of� nursing� and� midwifery� in� protecting� and� improving� public� health� care,� one� of� the� six� key� action� areas� of� the� national� nursing� midwifery� and� care� strategy,� Compassion in Practice�(DH,�2012). This� strategy� is� designed� to� support� the� delivery� of� the� values� and� behaviours� of� the� ‘6Cs’,� now� the� principal� driver� for� nursing� in� the�wake�of� the�publication�of� the�Francis� Inquiry,�which�revealed�suboptimal�standards�of�
- 3. care�at�the�Mid�Staffordshire�NHS�Foundation� Trust�(Francis,�2013). To�help�achieve�this,�Public�Health�England�� (PHE)�has�prioritised�five�key�areas�for�action: ■■ Designing� strategies� to� promote� longevity� and� improved� health� outcomes� by� tackling� preventable� deaths� and� ill� health� associated� with� smoking,� hypertension,� obesity,� poor� nutrition,� suboptimal� mental� health,� insufficient�exercise�and�alcohol�abuse ■■ Decreasing� the� personal� suffering� caused� by� disease� and� disability� by� concentrating� resources�on�preventing�and�recovering�from� the�long-term�conditions�that�have�significant� impact�on�lives,�including�dementia,�anxiety,� depression�and�drug�dependency ■■ Safeguarding�the�population�from�infectious� diseases�and�environmental�hazards,�including� antibiotic-resistant� infections.� PHE� has� reported�that�cases�of�measles�in�England�are� at� their� highest� recorded� levels� since� 1994,� with�1168�confirmed�cases�between�January� and�May�2013 ■■ Helping�families�to�give�children�and�young� people� the� best� chances� in� life� through� working� with� health� visiting� and� school� nursing,� family� nurse� partnerships� and� the� Troubled�Families�programme�(Department� for� Communities� and� Local� Government,� 2013).� Through� this� programme,� the� government� is�committed� to�working�with� local� authorities� and� their� partners� to� help� the� estimated� 120�000� troubled� families� in� England� to� improve� their� life� trajectories� radically� by� 2015.� This� is� because� the�
- 4. government� is� committed� to� ensuring� that� the� children� in� these� troubled� families� are� afforded� a� better� life� and� simultaneously� reducing�the�burden�on�the�Exchequer ■■ Improving� health� in� the� workplace� by� encouraging� employers� to� support� their� staff,�and�those�moving�into�and�out�of�the� workforce,�to�lead�healthier�lives. To� achieve� these� priorities,� PHE� will� promote�‘place-based’�public�health�systems.�In� simple�terms,�‘place-based’�approaches�are�one� strategy� to� improve� the�health� and�wellbeing� of� local� communities� where� specific� groups� of� individuals� can� be� targeted� for� health� interventions.� The� Tasmanian� Government,� Australia� (2012),� has� produced� a� detailed� position� paper� on�‘place-based’� public� health� systems,� in� which� stakeholders� engage� in� a� collaborative� process� to� address� health� issues� within� a� geographic� space,� such� as� a� neighbourhood� or� specific� community.� This� system� recognises� that� there� is� a� complex� relationship�between�people,�place�and�health.� People� who� live� in� disadvantaged� areas� and� who� may� be� affected� by� social� exclusion,� unemployment,� poor� education� and� poor� physical�environments�may�have�a�greater�risk� of� poor� health� and� wellbeing� than� those� in� affluent�areas.�It�is�this�difference�between�the� health� and� wellbeing� outcomes� of� poor� and� wealthy�communities�that�can�be�described�as� ‘place-based� health� inequity’.� Given� the� UK� economic� downturn,� it� is� not� surprising� that� ‘place-based’�public�health�systems�are�seen�as�
- 5. a�way�of�targeting�precious�health�resources. Independence, wellbeing and health The� first� action� area� of� ‘Compassion� in� Practice’� concentrates� on� helping� people� to� stay� independent,� maximising� wellbeing� and� improving� health� outcomes.� It� is� this� action� area� that� the� nursing� and� midwifery� contribution�to�public�health�focuses�on.� Helping all nurses and midwives to maximise their role in public health This�aspect�of�the�new�guidance�document�is� designed� to� illuminate� the� contribution� that� all�registered�nurses�and�midwives,�irrespective� of� their� place� of� work,� can� make� to� helping� people�mange�their�own�health�and�wellbeing� better.�Nearly� 20� years� ago,�Nutbeam� (1996)� was� arguing� for� the� necessity� of� accurately� defining�what� constitutes� evidence�of� success� in� health� promotion;� the� nursing� profession� is� now� helping� to� build� this� evidence� base.� The� government� believes� that� nurses� should� take� opportunities� at� every� patient� contact� to� maximise� wellbeing� and� improve� health� outcomes� and,� where� possible,� reduce� inequalities.� It� needs� to� be� stressed� that� the� Professor Alan Glasper discusses the latest Department of Health initiative to enhance the public health role of nursing and midwifery in improving health and wellbeing in society The nursing and midwifery contribution to public health
- 6. British�Journal�of�Nursing,�2013,�Vol�22,�No�15� 901 healthcare policy © �2 01 3� M A �H ea lth ca re �L td government� itself� has� been� accused�of� empty� rhetoric� after� it� was� revealed� in� the� popular� press� that� it� had� shelved� plans� to� make� plain� packaging� of� cigarettes� compulsory� and� abandoned� its� much-vaunted� aspiration� to� introduce�a�minimum�unit�alcohol�price�(Mail� Online,�2013).�Despite�this,�the�new�guidance� document� illuminates� how� nurses� can� make� every� person� contact� count� in� the� vision� for� improved� public� health,� both� locally� and� nationally.�Measures�include,�among�others:
- 7. ■■ Promoting�compassion�in�practice�in�social- care�settings ■■ Developing� the� nursing� and� midwifery� contribution� to� the� promotion� of� good� mental� health� and� the� reduction� of� health� inequalities� for� people� with� learning� disabilities ■■ Maximising� the� leadership� role� of� public- health�nurses�and�developing�a�new�model�to� promote�the�public-health�role�of�midwives ■■ Enabling�nurses�to�learn�the�skills�of�health� promotion�to�optimise�every�patient�contact ■■ Enhancing� school� nursing� to� improve� the� health�and�wellbeing�of�children�and�young� people ■■ Supporting�nurses� in�better� helping�people� with�dementia� ■■ Promoting� health� visiting� to� showcase� its� pivotal� role� in� helping� children� and� their� families� get� the� best� start� in� life.� It� is� important� to� direct� efforts� towards� the� prevention�of�child�abuse�and�neglect�before� patterns� of� abuse� are� established� within� families�(MacMilllan�et�al,�2005)�� ■■ Ensuring� that� nurses� are� given� access� to� appropriate� technology� and� highlighting� the�contribution�of�the�National�Institute�of� Health�and�Care�Excellence�(NICE)�through� development�of�an�accessible�evidence�base� for�public�health�nursing ■■ Promoting�interagency�working. What can nurses do to maximise the ‘nursing and midwifery contribution to public health’? There�are�a�number�of�actions�that�nurses�and�
- 8. midwives� can� take� to� make� this� new� vision� for�public�health�work,�configured�around�the� individual,�the�community�and�the�population: ■■ Public health and the individual:�The� vision�for�public�health�seeks�to�make�every� nursing� contact� count,� with� every� nurse� being� able� to� offer� up-to-date� advice� to� patients� and� their� families,� based� on� best� evidence�pertinent�to�health�and�wellbeing.� Nursing� advice� that�helps� individuals�make� lifestyle� choices� to�prevent�health�problems� should�be�given�at�every�opportunity.�Nurses� should�be�able�to�signpost�individuals�to�the� appropriate�people�or�agencies�that�can�best� help�them.�Additionally,�the�role�of�the�nurse� is�to�help�patients�identify�and�set�achievable� health� goals,� and� be� able� to� refer� them� to� others� within� the� multiprofessional� team� when�concerns�are�identified ■■ Public health and the community:� Nurses�working�in�the�community�should�be� able� to� assess,�plan�and�provide�community� needs,� especially� within� hard-to-reach� groups,� such� as� traveller� communities,�who� fail� to�access�health� services.�As�part�of� this� new� vision,� community� nurses� need� to� be� enabled� to� engage� with� communities� and� those� who� commission� services,� and� to� plan,� implement� and� subsequently� review� health� ‘place-based’� projects.� To� achieve� this,� community� nurses� need� to� develop� enhanced� communication� strategies� to� be� more�able� to�articulate� the�health�concerns� of� their� areas� of� health� jurisdiction,� and� to� collect� and� use� population-level� data� to�
- 9. underpin�their�assertions ■■ Public health and the population: Community�nurses� and�midwives� need� to� be� more�able�to�influence�and�configure�both�the� political�and�policy�agendas�directly,�so�that�they� can�better�represent�their�healthcare�constituents.� This�will�result�in�maximised�opportunities�for� improving� population� health� and� addressing� health� inequalities.� Better� engagement� with� strategic�partners�and�the�public�is�necessary�to� identify� health� need,� set� objectives� and� health� priorities,�and�the�methods�to�measure�success� accurately.� In� building� sustained� community� health� capacity,� improvement� of� health� and� wellbeing,�and�reduction�of�health�inequalities,� should� be� achievable.�To� bring� this� vision� to� fruition,�the�nursing�and�midwifery�community� teams� must� be� enabled� to� develop� the� skill� toolkit� they� need� to� deliver� the� envisaged� service�improvements.� Conclusion The� Public� Health� Outcomes� Framework,� launched�in�May�2013,�is�designed�to�improve� and�protect�the�nation’s�health�and�wellbeing� with� a� rapid� improvement� in� the� health� of� the� poorest� members� of� society.� This� new� guidance� document,� Nursing and Midwifery Contribution to Public Health,� recognises� that� nurses� and� midwives� are� pivotal� in� making� this� vision� for� the� nation’s� health� a� reality.� The� whole� of� the� nursing� workforce,� wherever�and�whenever� they�work,�must�be� enabled� to� contribute� to� improvements� in� public�health� at� every� level—promoting� the� health� of� the� individual,� the� community� in�
- 10. which� they� work� and,� ultimately,� the� entire� population.��� BJN Department� for� Communities� and� Local� Government� (2013)� Helping Troubled Families Turn their Lives Around.� https://www.gov.uk/government/policies/helping- troubled-families-turn-their-lives-around� (accessed� 23� July�2013) Department� of� Health� (DoH)� (2012)� Compassion in Practice.� http://www.england.nhs.uk/wp-content/ uploads/2012/12/compassion-in-practice.pdf� (accessed� 23�July�2013) DoH�(2013)�Public�Health�Outcomes�Framework�2013�t o� 2016� and� technical� updates.� http://tinyurl.com/d45acrg� (accesssed�23�July�2013) Department� of� Health� and� Human� Services,� Tasmania,� Australia� (2012)� Place-Based Approaches to Health and Wellbeing.� http://www.dhhs.tas.gov.au/_data/.../Place- ased_Issues_Paper_V1.0.pdf�(accessed�23�July�2013) Francis�R�(2013)�Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry.� http://www.midstaffspublicinquiry.� com/sites/default/files/report/Executive%20summary.� pdf�(accessed�23�July�2013) King’s� Fund� (2012)� Data Briefing: Emergency Hospital Admissions for Ambulatory Care-sensitive Conditions.�http:// www.kingsfund.org.uk/publications/data-briefing- emergency-hospital-admissions-ambulatory-care- sensitive-conditions�(accessed�23�July�2013)
- 11. MacMillan�HL,�et�al�(2005)�Effectiveness�of�home�visi tation� by�public- health�nurses�in�prevention�of�the�recurrence�of� child�physical�abuse�and�neglect:�a�randomised�controlle d� trial.�Lancet�365(9473):�1786–93 Mail� Online� (2013)� Stubbed Out.� 23� July.� http://tinyurl. com/kxxtqlg�(accessed�23�July�2013) Nutbeam�D�(1996)�Health�outcomes�and�health�promotio n:� defining�success� in�health�promotion.�Offic J Aust Health Promot Professionals�6(2):�58–60 Public� Health� England� (2013)� Nursing and Midwifery Contribution to Public Health.� https://www.gov.uk/ government/publications/nursing-and-midwifery- contribution-to-public-health�(accessed�23�July�2013) Key PoInTs n The challenges to the NHS over the forthcoming years to maintain and enhance public health and well-being are vast and complex n The new guidance document which describes the nursing and midwifery contribution to public health is designed to address the challenges to the health and well-being of people in society. n Every registered nurse and midwife has a duty to make every patient /client contact count in
- 12. promoting public health. n Place-based approaches are one strategy which can be used by community nurses and midwives to improve the health and wellbeing of local communities. n The government want to maximise the leadership role of public health nurses and midwives. Copyright of British Journal of Nursing is the property of Mark Allen Publishing Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Week 5-Determining the Change / MICROSOFT VS TESLA ARE 2 CHOSEN COMPANIES For an overview of this part of the course project please watch the following video. Select a diagnostic model (see Chapter 4) that you and your team can utilize to review aspects of change activities and actions that have been taken by the companies chosen. For this analysis, we are looking at the parts of the companies as well as their strategies, as surmised by your earlier research. It is acknowledged that this information will not be complete as you are looking at these companies as an outsider, but a thoroughly researched paper will give enough data to allow some well- defended assumptions on your part. Here’s what to do. 1. Select one diagnostic model (i.e., 6-box, 7S, congruence, or
- 13. one of the others) to apply to the two chosen companies. Choose the model that you and your team feel best identifies and measures the relevant aspects of the organization's performance. 2. Apply the data obtained in your research through an analysis of the appropriate chosen model. This will allow you and your team to create a diagnosis of where each company is today (as per the criteria of the model). 3. Create a SWOT analysis for each of the two chosen companies change plans/programs, utilizing information obtained in the diagnosis (strengths, weaknesses, opportunities, threats). 4. As a team, compare the two company analyses to each other and offer your perspective (value judgment) of the effectiveness of the changes made to date in each case. 5. Identify potential areas of resistance that may occur and at least one strategy to respond to each. (This will most likely come from your weaknesses/threats section of your SWOT. If not, take another look at your SWOT.) 6. Make recommendations for further actions within the organizations and the rationale chosen for these recommendations. 7. Write your team paper, including each of the above sections and analyses. Grading Rubric Item Total points Provide a comprehensive review of the change diagnostic model chosen that details the components included as well as some background about the model itself through research from the author(s) 25 Include your team's rationale defending why that particular model was selected. You can utilize a review of internal/external pressures that have affected the companies chosen. 25
- 14. Create a SWOT analysis based on the above. Compare the two company analyses to each other, and offer your team's perspective (value judgment) of the effectiveness of the changes made to date in each case. 20 Address potential areas of resistance that were encountered or that you anticipate may be encountered and possible actions to minimize the negative effects of such resistance. 20 Include your team's recommendations for further actions within the organizations and the rationale chosen for these recommendations. 20 Use four new references, properly cited. 10 Total points 120