Running head: NURSING ROLES FOR FALL PREVENTION Student Name: Joan Kronlein

Nursings Leadership Role in Population Based Issues Paper Rubric Section Content Guidelines Clearly identifies two nursing roles needed to carry out community project. Role of direct contact nurse Identifies possible agency for nursing role. Identifies a leadership role a nurse might take in part of the proposal. Clearly explains what leadership characteristics would be needed to be effective in carrying out this role. Links to ANA Standards of Professional Practice. Role of leader/manager nurse Identifies possible agency for nursing role. Identifies a leadership role a nurse might take in part of the proposal. Clearly explains what leadership characteristics would be needed to be effective in carrying out this role. Links to ANA Standards of Professional Practice. Analysis How are the roles similar? How are the roles different? How could the leadership roles for both nurses explained above impact the political arena related to your population based health concerns. What are the implications for the different skills needed? Reflection Which of your skills might be most suited to each role? What role requirements would be a challenge for you? What might you do to be competent in either role?

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Comments: You did a great job with your paper. A great deal of your analysis was seen throughout the paper. It sounds like you have a good understanding of the differences between the roles. Jo

NURSING ROLES FOR FALL PREVENTION

Nursing Roles for Fall Prevention: An Analysis using a Tier Structure Joan Kronlein RN Ferris State University Nur 340/Spring 2012/Doerr

NURSING ROLES FOR FALL PREVENTION Abstract

The Quad Council of Public Health Nursing Organizations, which includes the American Nurses Association, lists core competencies for public health nurses that fall within 3 Tiers. Tier 1 encompasses the entry level public health nurse, Tier 2 encompasses Tier 1, but also with supervisory or middle management duties, Tier 3 is the leadership level of an organization. For this paper, the role of direct care and leader roles are discussed within the context of falls within the elderly of Kent County, and compared. The 2 roles overlap at Tier 2, or the mid supervisory level. This author has skills in communication both verbal, and non-verbal, plus written communication, coupled with a desire for leadership. However, this nurse has limited leadership and public speaking experience. This nurse will be mentored by a respected and experienced leader, and will seek out public speaking opportunities.

NURSING ROLES FOR FALL PREVENTION Nursing Roles for Fall Prevention: An Analysis using a Tier Structure Nursing roles for public health issues like falls in the elderly population of Kent County are directly related to the individual, family, groups and the population as a whole. The roles of direct contact nurses and managers/leader nurses have overlapping and separate duties for this public health issue. According to the Quad Council of Public Health Nursing Organizations

(Quad Council), job descriptions for PHNs [public health nurses] may reflect components from each level, depending on agency size, structure, leadership, and services (Assumptions section, para. 7). An analysis of Kent County data unique to falls is first described as a basis for the problem in Kent County. A comparison of the roles of the registered nurse related to falls prevention is the main subject. This comparison is based on the Quad Councils tier and domain structures. According to the Quad Council (2011), we used the Public Health Nursing: Scope and Standards of Practice (ANA, 2007) document as a reference to ensure continuity and consistency with those standards (The following assumptions, para. 7). Lastly, included is an analysis of this Registered Nurses skills, challenges, and plan for competence in the public health sector. Analysis of Data The Connecticut Collaboration for Fall Prevention (CCFP) states common, treatable health problems and hazards [associated with falls] include problems with walking or moving around, medications, foot problems or unsafe footwear, blood pressure dropping too much on getting up, problems seeing, and tripping hazards at home (2010, Preventable, para. 2) as the most frequent causes of falls. Based on an assessment of Kent County, unintentional harm, specifically falls, is an issue in this community. Kent County has a higher average incidence of falls compared to Michigan. According to the Michigan Public Health Institute (2011) on behalf

NURSING ROLES FOR FALL PREVENTION of Kent County Working Together for a Healthier Tomorrow, mortality rates are higher in Kent County for events such as falls [and] deaths attributable to falls in Kent County (14.8/100K

population) are nearly twice as high as the rates for Michigan (7.7) and the US (7.3) (p. 41). On average, unintentional injury (including falls) and poisoning were more prevalent in zip code 49504 (Michigan Public Health Institute, 2011, p. 44). An analysis of the data shows that the homes in this zip code were all built before 1939 and people in this area have incomes that most frequently fall between fifteen to twenty thousand dollars per year (City-data.com, 2011, Table: Year House Built and Table: Estimated household income distribution in 2009). This presents significant information about the possible reasons for falls; coupled with the fact that fatal fall rates increase directly with age, [and] 89% of the fatal falls in Kent County were among residents 65 years of age or older(Michigan Public Health Institute, 2011, p. 43). Quad Counsel Tier Structure There are 3 tiers within the structure of competencies for public health nurses from the Quad Council. Tier 1 [competencies] reflect PHN practice primarily directed at individuals, families, and groups within the community; Tier 2 reflects PHN practice primarily directed at communities or populations; Tier 3 reflects systems-level leadership demonstrated by PHNs (Quad Council, 2011 Assumptions, para. 3). the Tiers are defined on a continuum, so PHN practice in each tier assumes the competencies of the previous tier (Quad Council, 2011 Assumptions, para. 5). Thus, the PHN at Tier 3 must possess and be willing to use the competencies from all 3 tiers. There are eight domains within each are the 3 tiers of competencies. The domains are analytic and assessment skills, policy development/program planning skills, communication skills, cultural competencies skills, community dimensions of practice, public health science skills, financial planning and management skills, and leadership

NURSING ROLES FOR FALL PREVENTION and systems thinking skills (Quad Council, 2011). For this analysis of roles, the direct contact nurse has duties within tier 1 and 2, while the manager or supervisor is in Tier 3. Direct Contact Nurse Analytic and Assessment Skills A direct contact public health nurse is involved with activities within Tier 1 and 2. With

regards to fall prevention within the elderly population, this nurse would be responsible for: data collection on falls; using available research and evidence to understand the strengths and weaknesses of the elderly; understanding demographic information regarding the location and population; using valid falls risk assessment tools; collecting, interpreting and documenting data on falls. The direct contact nurse assesses, diagnosis, plans, implements, and evaluates falls and fall prevention projects for appropriate outcomes. The direct contact nurse leads educational programs for the community, providers, groups, families, and individuals in falls prevention. This nurse uses analytic skills to monitor that research being done, on behalf of the elderly for fall prevention, is of the highest quality, but can also identify where information is missing. The nurse understands the legal and ethical ramifications of data collection and practices evidencebased Public Health Nursing to promote the health of individuals, families, and groups (Quad Council, 2011). Policy Development and Program Planning Skills The direct contact nurse understands the agenda, initiatives, and goals of fall prevention strategies within the governments Healthy People 2020 criteria and plans fall prevention activities accordingly. This nurse uses theoretical models and evidence to plan interventions. The direct care nurse will plan a community home needs assessment, plan and implement vision screening clinics, will discuss medications with individuals, and educate people about the

NURSING ROLES FOR FALL PREVENTION common causes of falls. The direct contact nurse analyzes disparities in health. In regards to the

elderly population in Kent County, the direct contact nurse would understand that quality of life is unequally distributed and it depends on:If you can be independent, because self-worth is tied to your ability to take care of yourself, for older adults [, this becomes the issue after falls] (Community Health Needs Assessment for Kent County, Michigan {Kent County CHNA}, 2012, Quality of Life, p. 5). The nurse follows public health nursing laws and makes sure they are followed by others. The direct contact nurse is part of a team, facilitates, and manages teams. The nurse understands quality of care, and the future endeavors of the government to only pay for quality services (Quad Council, 2011). The direct care nurse can give testimony to policy makers about the elderly and risk of falls. Communication Skills The direct contact nurse effectively and efficiently communicates information, both verbally and written about falls (data, research, and findings) to the appropriate people or organizations, like local health departments, supervisors, communities, and individuals (Quad Council, 2011). Cultural Competency Skills The direct care nurse will work with the elderly population while understanding and interpreting their unique diverse determinants of health. The nurse will plan education around what is important to the elderly, like self-care and independence. She will also plan for hearing impairment, vision impairment, and mobility problems within this population (Quad Council, 2011). Community Dimensions of Practice Skills

NURSING ROLES FOR FALL PREVENTION The direct care nurse identifies community partners, both individual and groups, and

works with them. In regards to fall prevention, the community partners would include the Area Agency on Aging of West Michigan, Kent County Health Department, Kent County Prevention Coalition (network180), Healthy Homes Coalition, and Lions Club-Kent County, to name a few (Quad Council, 2011). Public Health Sciences Skills The direct care nurse understands, incorporates and utilizes knowledge of public health to improve the health of the elderly in falls preventions: examples include, writing research in professional journals and using ethical behavior when gathering data on falls and fall prevention (Quad Council, 2011). Financial Management and Planning Skills The direct care nurse for falls prevention would give input on and develop a program budget, while supervising that the program operations stay within budget. Also, the direct care nurse would understand that money needs to be well spent, or helping the most people from the money available. As in a falls prevention program, a decision would need to be made to provide money for each home for repairs, or on educational programs for the individual, families, or Kent County. The direct care nurse is knowledgeable about emergency preparedness and works with the authorities of Kent County to prepare for a disaster, especially how to care for the elderly at that time (Quad Council, 2011). Leadership and Systems Thinking Skills The direct care nurse uses ethical standards in relationships with individuals, families, groups, populations, and within the practice of public health nursing. Leading and participating in groups with a stake in the elderly or fall prevention programs, is also a role of the direct care

NURSING ROLES FOR FALL PREVENTION nurse. The nurse understands system theory as health problems identified at the local community level often have causes or contributing factors that originate in the broader social, economic, environmental, or political systems (Harkness and Demarco, 2012, p. 137). Falls in

the elderly of Kent County, as seen in the above analysis of the data, are related to ages of homes in the area. The direct care nurse would then analyze the reasons why the elderly population lives in the homes where they do. The direct care nurse also implements mentoring and education opportunities to co-workers, and new nurses to promote public health nursing (Quad Council, 2011). In Kent County, the direct care nurse could take along a student nurse and assess a home for falls risk. Public Health Nurse Leader Role The public health nurse incorporates all of the previous direct care nursing activities (from tier 1 and 2) that he or she has shown competency in along with his or her experiences, for the Public Health Nurse Leader role. This nurse falls within Tier 3 of the Quad Councils competencies. Tier 3 is described as systems-level leadership demonstrated by PHNs (Quad Council, 2011 Assumptions, para. 3). While the direct care nurse can be a leader of people and systems, the Public Health Nurse Leader would design the systems and design solutions to care delivery systems. The Public health Nurse Leader is a more global leader in that he or she can interact with the highest stake holders, like the federal government, or sit on governmental committees that design policies (Quad Council, 2011). A Comparison of Roles for Fall Prevention Within Tier 2 of the Quad Councils competencies are many overlaps between the direct care nurse and the public health nurse leader. The nurse leader is continually assessing, diagnosing, planning, implementing, and evaluating strategies to improve a populations health.

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The direct care nurse is doing the same, only instead of at the population level; this nurse could be working with individuals, families, or groups. The Nurse Leader is working with larger populations to improve health. Both the direct care nurse and the Nurse Leader give testimony on policy, the leader would most often establish the policy or system. As in the case of falls in the elderly population, the direct care nurse can lead the collection of data on falls and the community, but the Leader would then bring that information to the governmental committees, or the largest stakeholders, and form a potential plan for improvement of falls in Kent County. My Skills Most of my skills are well suited for the direct care nurse role, with small leadership opportunities throughout my career. With age and experience has come a desire for leadership activities that have a broader impact. I am able to see population problems, and enjoy working through possible causes. I enjoy looking at the government agendas, like Healthy People 2020, and analyzing how this is impacting my work and the community, as I work at a publicly funded university. I like to educate my peers on public policy that I become aware of, especially when my work has been impacted. I enjoy doing research, but wish I had more time for it. My strengths are in people skills. I am adept at reading body language, which helps when conflict arises. I am able to deal with it quickly, because I know there is a problem. I am a good mentor and educator. I love to write, and analyze. One weakness is my helper personality. Sometimes, I am not able to help people, which is frustrating. Another is I am not the best public speaker, unless I am passionate about the topic, then I am effective. I dont have a lot of opportunity to speak to groups. Another is my work environment and my position does not lend itself to leadership opportunities.

NURSING ROLES FOR FALL PREVENTION One way I am working on my weaknesses is by getting my BSN, and also my Masters Degree after that, although I am not sure which graduate degree to focus on just yet. Another

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way I am working on my weaknesses is to find a good leadership mentor. I have finally found a mentor that I respect, with the management experience to go with it. This person is a strong leader for strategic and organizational change, when it is based on evidence-based research. Conclusion There are differences and similarities between the direct care and public health leader roles. The roles overlap mostly in Tier 2 Quad Council competencies. The scope of leadership activities depends greatly on the type of organization and organizational structure where the nurse leader is employed. The direct care nurse can take on more leadership roles as the position allows. The direct care nurse is always using leadership skills with individuals, families and communities as he or she is the nurse having a direct impact on another.

NURSING ROLES FOR FALL PREVENTION References City-data.com. (2011). 49504 zip code detailed profile. Retrieved from http://www.citydata.com/zips/49504.html. Community Health Needs Assessment for Kent County, Michigan. (2012), Quality of Life. Retrieved from http://www.kentcountychna.org/strategy.html

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Connecticut Collaboration for Fall Prevention. (2010). Prevent falls: Preventable. Retreived from http://www.fallprevention.org/pages/fallfacts.htm Harkness, G. A. & DeMarco, R. F. (2012). Community and Public Health Nursing Practice: Evidence for Practice. Wolters Kluwer/Lippincott, Williams & Wilkins: Philadelphia. Michigan Public Health Institute. (2011). Kent County: 2011 community health needs assessment and health profile. Retrieved from http://www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf Quad Council of Public Health Nursing Organizations. (2011). Quad council competencies for public health nurses. Retrieved from http://www.astdn.org/downloadablefiles/2011%20QC%20Competencies%20PHN/Quad %20Council%20Competencies%20for%20Public%20Health%20Nurses.pdf

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