Community and Public Health Nursing for the CNL
Mid Term Exam
Please answer all three of the following essay questions. You can use your book / notes. Please be sure to answer all parts of the prompt and to include a detailed response. Please use APA formatting for responses and references.
Nurses have a responsibility to improve health outcomes. As a new nurse working in the Cherry Hill Neighborhood in Baltimore, the first course of action would be to conduct a needs assessment to determine the community’s healthcare needs. According to Maurer and Smith (2013), nurses should utilize a systematic approach of gathering information. When conducting the needs assessment, the nurse would strongly rely on epidemiology. Epidemiology refers to the structure used for the systematic study of disease, health, and conditions related to health status. The role of epidemiology in nursing is improving the health and well-being of the population. The nurse applies the epidemiology process to determine the interrelationship between the environment, heredity, and personal behaviors and how they impact the health status of individuals and groups of people. Likewise, the new nurse working at the Cherry Hill Neighborhood should apply epidemiology by engaging in research to determine the most prominent health issues facing the community. The nurse would also establish the role of genetics, health behaviors, and the environment of the community in promoting health status. The nurse should establish a solution that would solve the community’s health problems. When recommending a particular solution, the nurse should also consider the culture of the community (Rohlik & Krumwiede, 2020). The intervention has to be culturally appropriate for it to be successful.
Fragmented healthcare refers to the excessive specialization and the narrow focus of disease control programs. Fragmented healthcare is implemented to provide better healthcare services to a population with specific healthcare needs. Fragmented healthcare occurs when different healthcare providers or organizations fail to work together. Fragmented care occurs due to inefficient healthcare laws and regulations, financial constraints, poor data management, and lack of information on providing integrated healthcare services (Agha, Frandsen, & Rebitzer, 2019). In a clinical care setting, an example of fragmented healthcare is when one patient gets healthcare services from disparate healthcare providers. For instance, a patient with diabetes may get healthcare services from her physician, nurse, physiotherapist, and other care practitioners who do not coordinate to provide harmonious care to the patient. The patient may be subjected to similar procedures which could have been avoided if healthcare services were centrally coordinated. Disadvantages of fragmented care on the patient include poor outcomes and increased healthcare costs.
The negative impact of fragmented care is that it prevents the provision of holistic healthcare services. When healthcare is fragmented individuals from poor and marginalized groups suffer the most as they do not get the continuity of care. Maurer and Smith (2012) provide an example of the negative impacts of fragmentation. They indicate that healthcare services for the mentally ill are severely fragmented, which results in lack of alignment between the healthcare services provided by each state. As a result of the lack of alignment, there is lack of responsibility among levels of governments, agencies, and healthcare programs. Some essential services may be omitted due to lack of clear role responsibility. In addition, services for youth and children are also said to be fragmented as they are focused on treatment as opposed to the prevention and treatment of mental disorders. Stakeholders focus on the most immediate concerns while paying little attention to other deserving areas of healthcare. Eventually, the fragmented care becomes counterproductive as other areas of healthcare that had been ignored continue deteriorating, leading to imminent healthcare challenges.
One of the strategies to reduce fragmented care is shifting focus to treatment instead of prevention and promotion of better healthcare. Nurses should implement interventions that focus on preventing diseases and promoting better healthcare (Sin & Bliquez, 2017). As a result, nurses should be focused on the overall health of a patient, therefore promoting a holistic approach in the management of a patient. Another evidence-based strategy that should be implemented is assigning each patient a care coordinator who liaises with all the providers involved in the management of the patient. The benefit of having a care coordinator is that patient management uses a team-based approach that collaborates on all aspects of the patient’s care, resulting in better health outcomes (Wagner et al., 2017). Similarly, in a clinical setting, nurses should adopt a team-based approach to addressing patient care. The two interventions would be beneficial for patients having multiple and complex healthcare conditions who require coordination of care to ensure all aspects of their care are addressed to improve their general health and wellbeing.
The best approach to use when implementing the intervention is the Minnesota Wheel. The Wheel refers to a population-based practice model that proposes three levels of practice to address when proposing healthcare interventions. The three levels of practice include individual/family, systems, and the community. The Sandtown-Winchester neighborhood middle school faces the problem of preteen obesity that requires a socio-ecological model to address it. Therefore, the Minnesota Wheel approach should be applied to provide different solutions at each level of the practice. At the individual/family level, the Minnesota Wheel approach recommends placing focus on changing the beliefs, behaviors, and practices of the individuals and their families (Maurer & Smith, 2013). Similarly, the focus of the intervention will be on changing the attitudes of the girls and their families. The public health nurse should collaborate with the school nurse to hold meeting and seminars with the girls, where they will be provided with information on the benefits of physical exercise and healthy eating. The meeting will be held with all the girls to provide them with information on the negative impacts of high caloric intake and the health benefits of fruits and vegetables. The girls should also be provided with strategies to accommodate physical exercise in their day-to-day lives. They should be encouraged to walk, cycle, and take part in sporting activities available in school.
The community level approach should be focused on changing the school environment to reduce obesity prevalence. The Minnesota Wheel recommends targeting entire populations within the community (Maurer & Smith, 2013). The best approach is to make changes to the school environment to encourage healthy eating and physical exercises. The school nurse should hold a meeting with the school administrators requesting changes in the school menu and providing physical exercise tools and equipment to the students. The school menu should be changed to healthy, nutritious food that provides learners with the required nutrients. In addition, the school should provide healthy and organic food options in and reduce the number of carbonated drinks available to the students. The school should also purchase physical exercise equipment such as treadmills, jumping ropes, and weight lifts to promote physical exercise among the students.
The system-based level of the socio-ecological approach should focus on making changes to school laws to obligate school heads to provide healthy menus and facilities encouraging physical exercise among students. The system-based level of the Minnesota Wheel requires making changes to systems that impact population health (Maurer & Smith, 2013). Similarly, the community/ public health nurse should advocate for changes in policies that obligate school administrators to provide school students with healthy meal options. The public health nurse should play an active role in policy formulation (Polchert, 2020). The nurse may collaborate with other nursing leaders to draft policies that promote healthy menus and physical exercises in schools. The draft policies should be presented to educational agencies that have the authority to effect and implement policies governing the management of schools. The nurse should provide the relevant authorities with findings from evidence-based practice which demonstrate that healthy nutrition and physical exercise are successful interventions in preventing and managing obesity.
Agha, L., Frandsen, B., & Rebitzer, J. B. (2019). Fragmented division of labor and healthcare costs: Evidence from moves across regions. Journal of Public Economics, 169, 144-159.
Maurer, F. A., & Smith, C. M. (2013). Community/public health nursing practice: Health for families and populations. Elsevier Health Sciences.
Polchert, M. J. (2020). Evidence of transformative learning in public health clinical for RN2BSN students. Nursing Repository.
Rohlik, L., & Krumwiede, K. (2020). Transforming learning: Applying community and systems level interventions through a poster project. Public Health Nursing.
Sin, M. K., & Bliquez, R. (2017). Teaching evidence-based practice to undergraduate nursing students. Journal of Professional Nursing, 33(6), 447-451.
Wagner, E. H., Flinter, M., Hsu, C., Cromp, D., Austin, B. T., Etz, R., … & Ladden, M. D. (2017). Effective team-based primary care: observations from innovative practices. BMC family practice, 18(1), 13.
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