Running head: NURSINGS ROLE IN POPULATION BASED ISSUES

Nursings Role in Population Based Issues Cheryl Veres Ferris State University

NURSINGS ROLE IN POPULATION BASED ISSUES Abstract Rates of chlamydia and gonorrhea remain high in the 15 to 24-year-old population in Kent County, Michigan (Michigan Department of Community Health, 2012). Nurses can perform several roles in order to facilitate a reduction in these rates. Community change in this population can transpire with the collaboration of public health nurses in various levels of

practice and in varied environments and settings. The role of direct contact public health nurses can influence this population at the individual level by providing clinical services and the role of public health nurses in surveillance, disease investigation, and epidemiology can affect these rates indirectly at the countywide level. Preventing and controlling communicable disease is a necessary and critical aspect of assuring community health and is an affirmative duty of local health departments (accessKent, 2012, Communicable Disease and Epidemiology, Communicable Disease Surveillance section).

NURSINGS ROLE IN POPULATION BASED ISSUES Nursings Role in Population Based Issues

Our groups Planned Community Change Group Project addresses the rates of chlamydia and gonorrhea in Kent County, Michigan. According to the Centers of Disease Control and Prevention (2011), the surveillance data shows that chlamydia and gonorrhea rates in America are the highest in the 15 to 24-year-old age group. Kent County shows a pattern that supports these findings, as both of the sexually transmitted diseases are highest in this age group. Kent Countys rates of gonorrhea have dropped to approximately the same rate as the state level, but they are still higher than the national rate for this sexually transmitted disease (STD). Chlamydia, however, is statistically higher in Kent County than on the state level and much higher than national levels (Kent County Health Department, 2011). One of the main agencies we will utilize for this change is the Kent County Health Department. The nurses working in this agency have direct contact with our target population at the individual level. Another aspect of reducing these rates in an indirect capacity is in surveillance, disease investigation, and epidemiology. Both of these nursing positions would play a key role in rate reduction because the practice of public health nursing has demonstrated a significant impact on improving the health of the public through both population-based health strategies and interventions with families and individuals (Quad Council of Public Health Nursing Organizations, 2007, p.4). Kent County Health Department Direct Contact Nurse The Health Department operates five public health clinics throughout the county that offers various services. One of these operating services is a Personal Health Services (PHS) clinic. PHS offers screening, testing, counseling, referrals, and treatment of STDs including gonorrhea and chlamydia. Retesting in three months after treatment is recommended for persons who have tested positive for either gonorrhea or chlamydia. This nurse will also help the

NURSINGS ROLE IN POPULATION BASED ISSUES individual identify steps to avoid future infections. This can also include client casemanagement and contact follow-up care. Therefore, a Kent County Health Department nurse

would be in direct contact with individuals in this age grouping within this agency (accessKent, 2012, Personal Health Services). Additionally, health education, presentations, and promotion lessons can be provided in the classroom and in the community in order to reach this target population of 15 to24- yearolds. Topics that are covered can include prevention, testing, transmission, signs, and symptoms of infection and the presentations are age-appropriate and can be tailored to meet the needs of specific populations (accessKent, 2012, Health Education Programs, Communicable Disease section). Leadership Characteristics Strong leadership characteristics are necessary in performing as a clinical team leader when providing direct contact nursing care. These traits would include diligence. It is important that the direct care clinical nurse does not become complacent in the task of reducing the rates of infection as it may become discouraging at times when the desired goal is not met. This nurse should be able to identify potential and actual problems, and critically think through problem resolution. Compassion is also necessary, as the people who seek these services may already be embarrassed or afraid. Excellent listening skills are essential, both as a team leader and in working with the individuals. Having a strong sense of self is important because this position requires non-judgmental care, and the ability to provide non-judgmental begins with selfawareness. Being an effective educator is crucial, as education is a cornerstone of prevention. Additionally, the ages of the target population varies extensively, so it would be important to be able to decipher which educational materials would make the most impact and encourage

NURSINGS ROLE IN POPULATION BASED ISSUES adherence. Strong communication skills are needed in order to address day-to-day issues with

the agency team, and provide a stronger path for the message to be received by the individual or group. Cultural sensitivity is necessary as Kent County is culturally diversified and there are different attitudes about sexuality. This nurse should provide holistic care, remembering there are many components that constitutes the whole being, and ultimately affects personal behaviors. A clinical team leader should be a positive role model, both to encourage optimal outcomes for the individual and groups, as well as for the team. ANA Standards of Professional Practice Harkness and Demarco (2012) discusses that public health nursing is distinguished from other specialties by eight domains nursing practice. The leadership characteristics described for this position coincide with these standards of professional practice. Being able to analyze and critically think, plan appropriate educational opportunities, communicate effectively, show cultural competence, address community needs, and be a leader and role model for a team and the individual or groups, are all aspects that signify correspondence to these standards of practice. Kent County Health Department Indirect Contact Nursing There is a Communicable Disease and Epidemiology division at the Kent County Health Department. This division monitors occurrence rates of specific diseases on a community wide basis. Nurses who work in this division contribute to epidemiologist and surveillance aspects. These aspects cover the study of the distribution and determinates of health-related states or events in specified population and the applications of this study to the control of health problems as well as the ongoing systematic collection, analysis, and interpretation of outcomespecific data for use in planning, implementation, and evaluation of public health practice,

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respectively (accessKent, 2012, Communicable Disease and Epidemiology, Epidemiology and Surveillance sections). Leadership Characteristics In surveillance, this nurse would need outstanding critical thinking skills as this position involves collecting, analyzing, interpreting, and the distribution of public health data. Generating and monitoring disease reports for the community done after a disease is detected, the investigation determines the source of the threat, recognizes active cases and others at risk, and makes a determination of which control measures would be effective (Association of State and Territorial Directors of Nursing, 2008). Being highly observant and having a solidly developed holistic viewpoint is significant, as many variables within the population should be recognized and measured in epidemiology in order to understand the whole picture. This nurse must be flexible and be an excellent communicator as duties include maintaining relationships between primary care doctors and hospitals throughout the community. Collaboration among primary care doctors, hospitals, and the Kent County Health Department is imperative when detecting disease outbreaks in order to provide education to the public. The nurse epidemiologist would need to be supportive to the teams that are conducting investigations and be able to provide advice. Additionally, a high level of motivation, initiative, and thoroughness is necessary for research, design, implementation, and the evaluation of surveillance activities in order to prevent avoidable morbidity and mortality. It is essential that this nurse be highly proactive at the forefront, as these activities will establish the basis for health planning, policy development, and the allocation of resources for the communitys safety and health (Public Health Nursing, 2005).

NURSINGS ROLE IN POPULATION BASED ISSUES

ANA Standards of Professional Practice The skills and leadership characteristics of the nurse working in the Communicable Disease and Epidemiology division directly correspond with the Eight Domains of Public Health Nursing from the American Nurses Association in Harkness and DeMarco (2012). Analytical and assessment skills are a key component in epidemiology and surveillance in order to decipher particular components of outbreaks of infectious diseases. Strategic planning and development for educational materials and programs as well as recommendations for policy are an integral part of this division. Cultural competency is necessary as Kent County is culturally diverse, not only in understanding the population but also in being able to effectively communicate with all the of team players involved. This nurse would have established strong system thinking skills as would be important in comprehending the big picture. Analysis Both of these public health nursing roles exercise many of the same characteristics and traits. Both have the goal of improving and sustaining the health of a population. There are also some differences in how they would affect change. Both roles utilize core functions of analyzing, assessment, planning. They both require excellent communications skills as well. Critical thinking is used in both areas to identify risk factors to lead to effective interventions. The nursing roles both develop educational plans, but on different levels. Cultural competence is necessary in each role as well. The direct contact nurse working in clinical services needs basic public health science skills. However, a nurse epidemiologist working in the Communicable Disease and Epidemiology division would need all-encompassing public health science skills and would require more education in specific areas like microbiology and biostatistics. The

NURSINGS ROLE IN POPULATION BASED ISSUES division would provide the basis for preventive approaches in medicine and public health, whereas the clinical service direct contact nurse would be more apt to implement these approaches. Reflection When considering the aspects of both roles, I could see myself in both positions. I do

think that working as a nurse epidemiologist in the Communicable Diseases and Epidemiology division would be more fitting for me, but I am not currently in a position educationally speaking to take that position. I enjoy analyzing issues and using critical thinking skills to improve problem areas and am very motivated and determined. I appreciate the opportunity to work with individuals and groups, but am intrigued with the idea of unraveling a mystery and being a detective with surveillance, investigation in epidemiology. I would need additional skill sets that would come with advanced education in order to do this. Harkness and DeMarco (2012) state that associate degree prepared RNs can appropriately practice in community settings where care is directed toward the health or illness of individual clients rather than entire populations. It does mention thought that the baccalaureate degree nursing is the educational credential for entrylevel public nursing practice. At this time, I could become a clinical nurse working in the agency and providing direct contact care. After I complete the RN to BSN program, it would be possible to take on more responsibilities as this would assist in the ability to create more appropriate educational materials or presentation and utilize information more effectively. To fulfill the role in Communicable Diseases and Epidemiology division would require a Masters level education. I am not in a position to further my education upon completion of my BSN at this time. I will be considering in the future. One of the biggest challenges for me would be research and statistics. While I do enjoy doing research, I have had difficulties with statistics. I

NURSINGS ROLE IN POPULATION BASED ISSUES did do well in this class while in the BSN program, but I was unable to enjoy it because of the pressure of learning something that I felt was very complicated in a short amount of time. I would like to take another course in statistics so I could appreciate it fully and be able to enjoy using that capability more thoroughly and reliably.

NURSINGS ROLE IN POPULATION BASED ISSUES References accessKent. (2012). Communicable disease and epidemiology. Retrieved from https://www.accesskent.com/Health/HealthDepartment/CD_Epid/default.htm accessKent. (2012). Health education programs. Retrieved from

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https://www.accesskent.com/Health/HealthDepartment/Health_Promotion/Health_Educat ion.htm#Com accessKent. (2012). Personal health services. Retrieved from http://www.accesskent.com/Health/HealthDepartment/PersonalHealth/ Association of State and Territorial Directors of Nursing (ASTDN). (2008). Report on a Public Health Nurse to Population Ratio. Retrieved from http://www.phnurse.org/docs/PHN_to_Population_Ratio_2008.pdf CDC.gov. (2011). CDC fact sheet: STD trends in the United States. Retrieved from http://www.cdc.gov/std/stats11/trends-2011.pdf Harkness, G. A., DeMarco, R. F. (2012). Community and public health nursing: Evidence for practice (5th ed.). Philadelphia, PA: Wolters Kluwer /Lippincott Williams & Wilkins Kent County Health Department. (2011). Annual communicable disease summary. Retrieved from http://www.accesskent.com/Health/HealthDepartment/CD_Epid/pdfs/2011/EpiFocus201 0.pdf Michigan Department of Community Health (MDCH). (2012). Sexually transmitted diseases. Retrieved from http://www.michigan.gov/mdch/0,4612,7-132-2944_5320_5332--,00.html

NURSINGS ROLE IN POPULATION BASED ISSUES Public Health Nursing. (2005). The nurse role in infectious disease/epidemiology. Retrieved from http://publichealthnursing.webs.com/nurseepidemiologist.htm Quad Council of Public Health Nursing Organizations. (2007). The public health nursing shortage: A threat to the publics health. Retrieved from http://www.phnurse.org/docs/Quad_Council_PHN_Shortage_Paper_2007.pdf

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