We do not expect that every public health professional will be proficient in all nurses may notice an increase in disease and other health events as.
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Public health interventions: Applications for public health nursing practice Second edition Marjorie Schaffer, P hD, RN, PHN Susan Strohschein, DNP, RN, PHN (retired) Suggested citation: Minnesota Department of Health. (2019). Public health interventions: Applications for public health nursing practice (2nd ed.). Minnesota Department of Health Community Health Division PO Box 64975 St. Paul, MN 55164 -0975 651 -201 -3880 firstname.lastname@example.org www.health.state.mn.us To obtain this information in a different format, call: 651 -201 -3880.
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Contents Acknowledgements . 5 Foreword 7 Introduction . 8 Overview of evidence -based practice and related topics 17 Red wedge . 25 Surveillance . 25 Disease and health e vent investigation 40 Outreach 53 Screening .. 65 Case -finding . 78 In review 87 Green wedge . 91 Referral and follow -up .. 91 Case management . 104 Delegated functions . 115 In review . 128 Blue wedge . 131 Health teaching .. 131 Counseling . 142 Consultation . 155 In review . 165 Orange wedge 167 Collaboration 167 Coalition -building .. 181 Community orga nizing 193 In review . 204 Yellow wedge . 207 Advocacy 207 Social marketing . 220 Policy development and enforcement 237 In review . 248
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INTRODUCTION PUBLIC HEALTH INTERV ENTIONS | 5 Acknowledgements The 2019 evidence update of Public health interventions: Applications for public health nursing practice builds on the foundational work of Linda Olson Keller , DNP, RN, PHN, FAAN; Susan Strohschein, DNP, MS, RN, PHN A (retired) ; and L aurel Briske , MA, RN, CPNP (retired) . Their visionary leadership brought together public health lit -erature and the expert pr actice of public health nurses to make the Intervention Wheel a reality for everyday public health nursing practice. The contributions of Dr. Keller and Dr. Strohschein in the dissemination of the Intervention Wheel create a legacy and responsibility for all public health nurses in intervening to improve popu -lation health. Reviewers We are also grateful to our reviewers who read and critiqued drafts of individual in -tervention wedges. The reviewers asked good questions and made insightful com -ments, essential for revising this document for readability, clarity, accuracy, and ap -plicability to public health nursing practice. With thanks, to the following reviewers: Linda J.W. Anderson, DNP, MPH, RN, PHN Bethel University Linda Bauck -Todd, MS, RN, PHN Minnesota Department of Health Kathleen Bell, EdD, RN, PHN St. Catherine University Angela Bosshart, BSN, RN, PHN Hennepin County Bonnie Brueshoff, DNP, RN, PHN Dakota County Bethany Divakaran, DNP , MPH , RN, PHN Concordia University Kari Glavin, PhD, MSc, RN, PHN VID Specialized University Karen S. Goedken, MSN, PHN Hennepin County Pamela L. Guthman, DNP, RN -BC University of Wisconsin -Eau Claire Sheryl Jacobson, MS, RN Viterbo University Maren Jensen, RN, PHN Hennepin County Wendy Kvale, MS, MPH, PHN Minnesota Department of Health Janelle Lambert, BSN, PHN Minnesota Department of Health Karen Jorgensen -Royce, MSN, RN, PHN Wrig ht County Karen Loewenson, MA, RN, PHN, CNE St. Catherine University Stacie O’Leary, MA, RN, PHN, LSN Independent School District 197 Mary Orban, MA, PHN Minnesota Department of Health Patricia M. Schoon, DNP, MPH, RN, PHN Metropolitan State University
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INTRODUCTION 6 | PUBLIC HEALTH INT ERVENTIONS Jernell Walker, BSN RN, PHN Hennepin County Carol Wentworth, BSN , RN , PHN Carver County Maureen Wosepka, MSN, RN, PHN, LSN St. Catherine University Susan Zahner, DrPH, RN, FAAN University of Wisconsin -Madison Linda Reveling Smith, MPH, RN, PHN Winona State University Stephani e Rivery, DNP, RN, PHN Dakota County Amalia Roberts, DNP, RN, PHN Dakota County Anna Terry, MSN, RN, PHN Dakota County Project s taff Julia Ashley, MA, PHN Minnesota Department of Health Kristin Erickson, MSN, RN, APHN-BC Minnesota Department of Health Reviewer notes I found the formatting and updated evidence cited in the chapters much more clear and applicable to current practice. I believe the evidence tips ™ formatting makes the full ch apters for each intervention on the wheel a great deal more ﬁ readable ﬂ and easier for everyone to grasp. *** Overall, this is a very straightforward way for students and public health nursing pro -fessionals alike to refer to and know exactly what an intervention encompasses , as well as ideas for implementing the intervention, and how to stay in the public health nursing swim lane when working with other health care entities in the health care system and in communities. *** I was very impressed with the comprehensiveness of the intervention definitions, a p- plications, and evidence tips. *** I appreciated using stories and application questions as appropriate triggers for dis -cussion in my teaching practice.
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INTRODUCTION 8 | PUBLIC HEALTH INT ERVENTIONS Introduction Public health interventions : Applications for public health nursing practice , 2nd edition Background Under the lead ership of public health nurses , the Minnesota Department of Health (MDH) developed a manual, Public health interventions: Applications for public health nursing practice , to guide public health nursing practice. MDH distributed this manual, commonly known as the Public Hea lth Intervention Wheel, to public health departments and public health nurses in 2001. Informed by literature and expert practice, the Public Health Nursing Intervention Wheel framework provides a com -mon language that names the work of public health nurse s. Two articles published in 2004 provide details about the development and dissemi -nation of the manual: Keller, L. O., Strohschein, S., Lia -Hoagberg, B., & Schaffer, M. A. (2004). Population -based public health interventions: Practice -based and evidenc e-supported (Part I). Public Health Nursing, 21 (5), 453 -468. Keller, L. O., Strohschein, S., Schaffer, M. A., & Lia -Hoagberg, B., (2004). Population -based public health interventions: Innovations in practice, teaching, and management (Part II). Public Heal th Nursing, 21 (5), 469 -487. Public health nurses in Minnesota, across the United States, and in other countries, including Australia, Ireland, and Norway, embrace and use the Public Healt h Inter -vention Wheel (Anderson et al., 2018; Baisch, 2012; Bigbee, 2 012; Depke, 2011; Leahy -Warren, 2018; McDonald et al., 2015; Reilly, Collier, & Edelstein, 2011; Schaffer, Anderson, & Rising, 2016; Schaffer, Kalfoss, & Glavin, 2017). How has public health nursing practice changed? Since the 2001 dissemination of the Public Health Intervention Wheel, changes in the socioeconomic and political landscape triggered changes in public health nursing practice. Health care reform policy began to address social determinants of health, prevention, and population health in commu nity settings (Swider, Berkowitz, Valentine -Maher, Zenk, & Bekemeier, 2017; Bekemeier, Zahner, Kulbok, Merrill, & Kub, 2016 ) driving public health practice to respond in like manner. In response to the September 11, 2001 terrorist attacks and bioterrorism incidents, the U.S. federal government provided substantial funding to state and local governments for emer -gency preparedness activities (Katz, Attal -Juncqua, & Fischer, 2017). This funding led to including emergency preparedness activities and opportunit ies in public health nursing practice.
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INTRODUCTION PUBLIC HEALTH INTER VENTIONS | 9 At the same time, challenges to the public health infrastructure affected the availa -bility of resources and support for public health nursing practice. These challenges include insufficient funding , resulting in bud get cuts and loss of prevention and health promotion services; a declining public health workforce, including public health nurses (PHNs) ; and workforce issues, such as non -competitive salaries, retirements, technology changes, lack of diversity, and lack of formal public health training (Bekemeier et al. , 2016). In response to these events and challenges, public health nurses require increased skills in system – and community -level interventions. Strengthening the public health system and improving population health depends upon expertise in community en -gagement and partnership development (National Institutes of Health, 2011; Robert Wood Johnson Foundation, 2017). Decreasing resources for public health work de -mand that public health nurses work efficiently and effectively. Using best evidence to support interventions when collaborating with systems and communities improves po pulation health and reduces health care dollars spent on acute and crisis health care. This manual updates the best evidence for public health nursing interventions and provides PHNs with the knowledge and tools to design and implement effective interventi ons in their practice. How has the Public Health Intervention Wheel changed? All of the interventions and the five Intervention Wheel wedges remain the same. The authors simplified the manual content, and updated and aligned intervention definitions with n ew evidence found in the literature. Each intervention includes the following sections: Definition Practice -level examples (individual/family, community, or systems) Relationships to other interventions Basic steps for the intervention with application e xample Key points from evidence (summarizes relevant evidence with evidence levels) Wheel notes (concerns, thoughts, challenges relevant to the intervention) Reference list A few things to keep in mind when using the manual : Practice -level examples related to each intervention facilitate di stinguishing be -tween practice levels . Real examples from the literature and/or public health nursing experience form the basis of application examples related to the intervention basic steps . Key points from evidence inc lude research and non -research (evidence that re -flects expert practice in the public health field that has not come through a rig -orous research process) evidence . A story with application questions at the end of each intervention wedge en -courages consid eration of the intervention and facilitates application of the in -tervention™s basic steps .
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INTRODUCTION 10 | PUBLIC HEALTH INT ERVENTIONS Method The authors searched CINAHL (Cumulative Index to Nursing and Allied Health Litera -ture) as the primary database for evidence updates on public health interventions from 2000 to 2018. The name of the intervention combined with other terms, such as public health, public health nursing, intervention, community, and nursing nar rowed the search. For some interventions, alternative terms yielded additional arti cles, such as the use of health education for health teaching. Journals yielding a high number of ar -ticles addressing public health interventions included Public Health Nursing, the Journa l of Community Health Nursing, the Journal of School Nursing, the American Journal of Public Health, and the Journal of Public Health Management and Practice. Searching government health -related websites and textbooks provided other sources of evidence. Go vernment websites included the Centers for Disease Control and Pre -vention (CDC), the National Association of County and City Health Officials (NACCHO), the World He alth Organization (WHO), the U. S. Departmen t of Health and Human Services , and state health departments. Classic textbooks on some of the interven -tions provided evidence for each intervention ™s basic steps . The authors used the Johns Hopkins Nursing Evidence -Based Practice Model (Dang & Dearholt, 2018) to categorize evidence levels ( for further explanation of evidence -based practice , see Overview of evidence -based practice and related topics , on p. 16). Although all five levels of evidence support basic steps and key evidence points for interventions, lower levels of evidence predominate. Non -experimental studies pro -vide the primary basis for research evidence for interventions. Public health nursing interventions Public health nurses work in or out of schools, homes, clinics, jails, shelters, mobile vans, and dog sleds. They work with communiti es, the individuals and families that compose communities, and the systems that affect the health of those communities. Regardless of where or with whom they work, all PHNs use a core set of interventions to accomplish their goals. Interventions are action s that public health nurses take on behalf of individu -als/families, communities, and systems, to improve or protect health status ( Minne -sota Department of Health , 2001, p. 1). This framework, known as the Intervention Wheel , defines the scope of public health nursing practice by type of intervention and level of practice (individual/family, com -munity, or systems), rather than by the site of service such as home, school, occupa -tional health, clinic, and others. The Intervention Wheel describes the scope of prac -tice by what is similar across settings and describes the practice of public health nurs -ing at the individual/family, community, or systems level. The Intervention Wheel an -swers the question, ﬁWhat do public health nurses do?ﬂ and delineates pub lic health nursing as a specialty practice of nursing. These interventions are not exclusive to public health nursing , as they are also used by other public health disciplines, except for delegated functions.
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INTRODUCTION PUBLIC HEALTH INTER VENTIONS | 11 The Intervention Wheel : The ﬁhowﬂ of public he alth nursing practice The Intervention Wheel integrates three distinct and equally important components: 1. The population -basis of public health interventions 2. Three levels of public health practice: Individual/family Community Systems 3. Seventeen public health interventions: Surveillance Disease and health event investigation Outreach Screening Cas e-finding Referral and follow -up Case management Delegated f unctions Health t eaching Counseling Consultation Collaboration Coalition -building Community o rganizing Advocacy Social marketing Policy development and enforcement
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