Community/Public/Population Health Nursing: Key Concepts, Exams of Nursing

Download Community/Public/Population Health Nursing: Key Concepts and more Exams Nursing in PDF only on Docsity! NUR 1244-WK1 COMMUNITY/PUBLIC/POPULATION HEALTH NURSING: KEY CONCEPTS- About this course -The focus of community health nursing practice is on the health of communities and humanly diverse populations, including those at risk and those experiencing health disparities. Emphasis is placed on health promotion, public health, health care policy, health equity, and clinical practice 1. What topics will you learn about? What knowledge, skills and attitudes/approach will you gain and use to be successful in this class? 2. How will learning be supported and evaluated? 3. How might you bring an expanded community public health perspective forward to all patients in your nursing practice? KEY TOPICS~ FROM THE TOPICAL OUTLINE • Community and public health nursing • Health education/health literacy/ health promotion/disease prevention • Primary care in the community • Health advocacy and policy for public health • Population health • Epidemiology/infectious disease • Environmental/climate/Global health • Disaster nursing • Design thinking solutions GETTING STARTED- BEGIN YOUR DISCOVERY WITH THESE 4 QUESTIONS IN MIND… • 4 core questions : • What is the nature of the public health issue? How large of an issue is it? (provide statistics as to the magnitude of the issue using reputable sources.) which Healthy People 2030 Goal does it link to? • Are there certain populations that are impacted more than others with this public health problem? Identify and describe • Describe two to three key interventions that are currently being done to address the public health issue • Describe the key nursing role in efforts to fill the gaps that exist to positively impact the health problem and improve patient outcomes. Which of the nursing actions relate to those described in the Minnesota Health Wheel and the CDC’s 10 Essential Public Health Services? LEARNING OBJECTIVES: CLASS1 ~INTRO TO COMMUNITY PUBLIC HEALTH NURSING • Describe the purpose of public health and define the key terms • Recognize public health functions core to community health nursing -Determining and influencing the Public’s Health- WHAT DETERMINES THE HEALTH OF A POPULATION? Ensuring the Conditions for Population Health Biology 9. Evaluate 10. Research CORE FUNCTIONS AT GOVERNMENT LEVELS Assessment Policy developme nt Assurance Feder a l National tobacco public health surveillance Smoking ban on commerci al flights Federal grants for antismoking research State Monitor state tobacco use Increase tobacco tax Funding for campaign through proposition 99 Local Report an local tobacco use County laws prohibitin g smoking in bars Resources to help smokers quit in multiple languages -Topic Stakeholder Roles in Public Health- PARTNERS IN THE PUBLIC HEALTH SYSTEM Community Clinical CareDeliver y System Government P ublic HealthInfras tr ucture Employers and Businesses Social/ Societal Characteristi cs ; Total Ecology Academia Genes and The Media Health Behaviors \ Medical Care yoeduul yyeey o1qnd Buiseasou; Social Determinants of Health Education Accassand Quality Health Care Access and Quality Neighborhood and Built Environment Economic Stability Social and Community Context SCN acre) the Default pepaeu yoy jenpiaipul Bulsee.uy -Upstream thinking focuses on “how to solve problems before they happen” rather than “wait and respond” UPSTREAM THINKING… Community: -A group of people sharing common interests, needs, resources, and environment; an interrelating and interacting group of people with shared needs and interests DEFINING THE COMMUNITY AND ITS BOUNDARIES • Types of communities o Geopolitical- sharing geographical or political boundaries o Phenomenological- sharing beliefs, interests o Community of solution - working together to address a common issue o Society, nation, international, or Global groups • There can be fluidity with communities moving in and out of these categories • Community Health Nurses need to be aware of what type of community is the client, for assessment, planning and evaluation of programs ASSESSMENT OF A COMMUNITY • Purpose: To analyze assets, strengths, resources, needs and barriers Population Community Family Individual health issues Health Demographics Physical environment Health care systems ealth promotion and disease prevention Achieving health equity Addressing social determinants of health Sustainable Development Goals Global/International Efforts • State Efforts • Process: Gathering data about- o Concerns/ • Methods: o Windshield survey and Observation o Key informants and Stakeholders interviews ▪ Community Members ▪ Key personnel ▪ Statistics ▪ Community Health Profiles COMMUNITY HEALTH PLANNING • Systematic organization of a plan to address the • Priorities are determined BY the community • Objectives are set • Programs/projects are planned • Current Topics o H for populations DESCRIBING YOUR COMMUNITY • Where is your community? • What does your community look like? • Who is part of your community? • What makes your community and its people healthy? KNOWING THE GOVERNMENT LEVELS OF PLANNING & INTERVENTION o http://www.un.org/sustainabledevelopment/ sustainable- development-goals/ o Healthy People 2020/2030 http://healthypeople.gov New York State’s Health Improvement Plan https://www.health.ny.gov/prevention/prevention_agen da/2019- Epidemiological Data identified in the community assessment with the mutuall health impacting achievement of • National Eff rts 2024/background.htm • City/Municipal Efforts o http://www1.nyc.gov/site/doh/data/data-publications/profiles.page HEALTHY PEOPLE 2030- DTICH PROJECT START • Goals for Population Health o Attain high quality longer lives free of preventable disease, disability, injury and premature death o Achieve health equity, eliminate disparities, and improve the health for all groups o Create social and physical environments that promote good health for all o Promote quality of life, healthy development, and healthy behaviors across all life stages • Topic and objectives cover 42 broad areas linked to health and wellness -WK2. HEALTH PROMOTION/HEALTH LITERACY/MOTIVATIONAL INTERVIEWING/HEALTH EDUCATION- LEARNING OBJECTIVES -At the end of today’s class, students will be able to: • Discuss the role of the community health nurse to engage in health promotion • Differentiate use of upstream/downstream community health interventions • Discuss the Health Belief & Transtheoretical Model and Motivational Interviewing skill set when assessing and educating patients • Examine the impact of health literacy on health outcomes • Examine factors that affect a client’s ability to follow treatment plan -Asynchronous slides • Incorporate ways to create appropriate health education materials for Skills Day • Develop SMART goals HEALTH PROMOTION -First International Conference on Health Promotion 1986: created the Ottawa Charter for Health Promotion: -*”The process of enabling people to increase control over, and to improve, their health… HEALTH BELIEF MODEL: INFLUENCING FACTORS TO CHANGE **recognized by pt’s conception. Perceive acceptability- at risk. • Susceptibility: chances for health problem; likelihood of adverse outcome ex) overweight, genetics, family, hx, cultural view) • Severity: how serious is the health problem and its consequences (family life, financial, social); long-term diabetes, how serious the health problem is. Ex) physical limitation, social stigma, criticism) • Benefit: perceived sense of effectiveness of a behavior to prevent a health threat; stop smoking- decrease lung cancer risk. • Barriers: difficulties to actualize a health behavior (inconvenient, time consuming, expensive, unpleasant, painful, upsetting); may interfere with the motivation to perform the health behavior; can exercise from knee issue, understand what the pt’s barrier really are. • Cues to action: internal or external; motivated by outside or inside? Perceive self- efficacy. Coping mechanism- calms me down. Resolve their health issue. Pt’s readiness to change- are they proud? Achievement. Have they already met discernment? A cue to action is something that helps move someone from wanting to make a health change to actually making the change. (tight fit of clothes, physician recommendations) • Self-efficacy: confidence in one’s ability to take action; consistency*** is key. Have you thought about quit or patches? TRANS-THEORETICAL MODEL: TTM; model in public health. Individual conception- previous model. This model- if pt is ready to change. It’s not sequential. Not anticipate making them change. • Provides a framework for exploring if a client is ready to make changes in behavior • Movement through stages may or may not sequential TTM: STAGES OF CHANGE • Pre-contemplation: lack of interest • Contemplation: thinking about it; no action steps; maybe next time- contemplation. I really want to quit. We like to see progress. Little awards is important in maintenance stage** • Preparation: making a plan, taking steps toward change • Action: involved in an action plan and intent is to continue plan • Maintenance: continue to be engaged in change action plan • Relapse: was involved in a plan, not currently taking action but intends to be active again; it can happen at any time. TTM: POTENTIAL CHANGE STRATEGIES; feedback. It’s important to know your patient is fluctuating. • Pre-contemplation : increase awareness of need for change; personalized information about risks and benefits • Contemplation : motivate; encourage making specific plans • Preparation : assist with developing and implementing concrete action plans; help set gradual goals • Action : assist with feedback, problem solving, social support, and reinforcement • Maintenance : assist with coping, reminders, finding alternatives, avoiding slips/relapses • Termination : provide resources MOTIVATIONAL INTERVIEWING -Actions by nurses who engage in effective motivational interviewing: technique using for increasing motivation. What’s their current readiness. Really listening. Negotiating. Degree of pt’s readiness. Support and reinforce patient’s freedom. • Goal is to understand the patient’s frame of reference through reflective listening • Express acceptance and affirmation • Elicit statements from the patient that show problem recognition, concern, desire… • Seek to understand the degree of readiness of the patient- watch for patient resistance that could result from the interaction with the nurse- patient’s don’t want to feel forced or controlled by the clinician! • Support the patient’s freedom of choice A WORD ABOUT AMBIVALENCE • Ambivalence is often not recognized and appears as if the client has a lack of motivation to change; internal conflict- ambivalence. • A person may make statements that reflect the internal conflicts they may be experiencing from influencing factors • Resist trying to make it better or use persuasion statements • Encourage change talk through MI techniques ASSUMPTIONS OF MOTIVATIONAL INTERVIEWING; how their autonomy and competency is changed. • Most people move through a series of steps before changing their behavior • Change comes from within (internal) rather than from external drivers • Confrontation and negative messages are ineffective • Knowledge alone is not helpful • Reducing ambivalence is key to change • Difficulty adhering to medical instructions • Difficulty with self-management • Increased risk of hospitalization • Deteriorating physical and mental health • Higher health costs • Increased mortality risk MOST VULNERABLE TO HEALTH LITERACY PROBLEMS • People of all ages, races, incomes and education levels are affected by limited health literacy; languages- more repeat hospitalization. • Groups disproportionately affected: o Older adults o Racial and ethnic groups other than White o Recent refugees and immigrants o People with less than a high school diploma or GED o People with incomes at or below the poverty level o Non-native speakers of English o People with compromised health status WHAT ARE HEALTH LITERACY UNIVERSAL PRECAUTIONS? -“Assume all patients may have difficulty comprehending health information and accessing health services.” AHRQ (agency for healthcare research and quality) to simplify communication..? make health system easy to access to patients. population health. -Goals of instituting Health Literacy Universal Precautions: • Have organizations simplify communication • Make the health system easier to navigate for patients • Support patients own efforts to improve health EHNACING HEALTH LITERACY • Be culturally sensitive and provide information in the preferred language • Assess ability to read before providing written information. People are embarrassed to admit the problem • Picture based instructions promote better understanding of instructions • Use a “universal precautions” approach- assume most patients have difficulty understanding health information • Use clear, concrete communication • Be aware of sources of information o Family and friends o Media: Television, Radio, Newspapers o Social media o Schools active learning Use methods to stimulate senses Safety warnings Product pamphlets Nutrition and medicine labels Pre-test, post-test Teach-back method -Write in short sentences o Web sites o Health providers -HEALTH EUDCATION- HOW TO FACILIATE LEARNING IN HEALTH EDUCATION • Use • Establish a quiet, comfortable, uninterrupted • Assess Make information of learner • Provide information in • Use • Make • Proceed form • Generalize and chunks EVALUATION METHODS • Return demonstration • Use of games: • Evaluation of questions asked by participants TEACH BACK -Explain → Assess → Clarify → Understanding -Reminder, there is a power point presentation on Teach Back posted under the after class reinforcement. PRINTED INFORMATION: THE BASICS • Short sentences tend to be easier to read and understand for patients. sentence length should be words. Sentences should be written , and . -Helping individuals achieve health and wellbeing through their own actions Jeopardy in a conversational ideally less than less than 15 pace appropriately simple to complex learning positive repetitio n smal l • readines s environme nt relevan t -Select simple words • Words that are commonly used in conversation are the best to include in health messages. Shorter words tend to be easier to understand and more familiar to patients -Provide information in bulleted lists • Bullets help to separate information from the rest of the text. Information provided in lists is often easier and faster for patients to read and comprehend -Print in large, Sans-Serif font • Text should be written in Sans-Serif font (e.g., Arial) with a minimum font size of 12 pt. use of all capital letters should be avoided; only the first letter of words in text should be capitalized -Include sufficient white space • Large margins and adequate spacing between sentences and paragraphs will provide sufficient white space and prevent a document from appearing to be solid text. In general, text should be left-justified for easy reading -Use pictures/diagrams that individuals can easily relate to MORE STRATEGIES FOR HAND-OUTS • Highlight or underline key information Bolding and highlighting phrases or words can draw attention to essential information for patients. it should be used sparingly to differentiate key sentences or phrases from the rest of the text • Design passages to be action and goal oriented Written passages should be action and goal-oriented. And provide readers with a clear explanation of the purpose of the written material. Passages should clearly define what actions should be taken by the reader and why these actions are necessary • Group and limit instructional content Consider grouping information under common headings to promote understanding. Place key information at the beginning of a paragraph and be sure to limit the amount of instructional content that is given to what is essential for the patient to know and understand SMART GOALS • Specific • Measurable • Achievable • Relevant • Time-bound • Provide RNs with additional training • Empower RN clinical decision making with standardized protocols • Reduce triage burden to allow for other patient care activities • Structure teams to have a dedicated RN for the patient panel • Implement RN led visits • Implement PCP/RN co-visits • Deploy “tactical nurses” who develop care plan after daily huddles, see complex patients, take comprehensive history • Allocate RNs to specialized functions • Schedule RN for different roles such as triage or resource nurse • Train Mas and LPNs for new responsibilities • Clinical academic partnerships for innovation KEY POINTS • Chronic Disease Management is a major focus of future nursing care. This supports Healthy People 2020/2030 national goals & objectives, and the Institute for Healthcare Improvement (IHI) Quadruple Aims (improve population health, patient satisfaction, reduce per capital cost, and joy in work) • Client (patient) centered care medical homes are closing the gaps in quality care and improve client outcomes • Therapeutic communication has shifted to more effective models (i.e. motivational interviewing) that are more culturally sensitive and client (patient) centered • Nurses are part of an interdisciplinary team to shift from transitional care to quality transitional care regardless of the setting WHAT ARE NON-COMMUNICABLE DISEASE AND THEIR RISK FACTORS? • Non-communicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70% of all deaths worldwide • Almost three quarters of all NCS deaths, and 82% of the 16 million people who died prematurely, or before reaching 70 years of age, occur in low- and middle- income countries • The rise of NCDs has been driven by primarily four major risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets FEATURES OF CHRONIC CONDITIONS IN THE 21ST CENTURY • There is no cure • Goal is to reduce the disease burden • High co-morbidity rate • Need for patient engagement in self-care behaviors • Access to continuity of care still limited especially in relationship to social determinants of health • Most resources are still more directed toward acute care, but this is changing… for example, Population Health Management IMPACT OF CHRONIC DISEASE • Physical/mental suffering. Depression • Impaired mobility; functional ability. Inability to work • Substantially reduced quality of life • Constraints on social and family life • Loss of independence • Loss of income with concurrent high medical/pharmaceutical costs • Isolation, shame, stigma, feelings of loss, fear of ‘becoming a burden’ BARRIERS TO EFFECTIVE CHRONIC DISEASE MANAGEMENT • Ineffective application of acute care models for chronic disease • Rushed practitioners not following evidence-based practice • Lack of care coordination & communication • Lack of interdisciplinary health team to address complex needs in chronic disease • Lack of active follow-up to ensure best outcomes • Inadequate use of community resources ROLE OF THE NURSE IN CHRONIC CARE MANAGEMENT -Goal for Health Care Providers: Facilitate an individual’s management (self- care) of their illness & maximize their quality of life -Nurses: • Are members of the interdisciplinary team • Coordinate care from multiple settings • Perform holistic client assessments • Teach & coach clients • Engage clients at all levels of prevention • Utilize effective communication: including motivational interviewing • Involve client and caregivers in decision making WHAT IS THE PATIENT-CENTERED MEDICAL HOME (PCMH)? • The medical home is a model or philosophy for achieving primary care excellence so that care is received in the right place, at the right time, and in the right manner that best suits a patient’s needs • PCMH is patient (client) centered, comprehensive, team- based, coordinated, accessible, and focused on quality and safety. Primary care team is focused on caring about and caring for the patient • Technology- patient can communicate with team through email, video chat, after-hour phone calls. Mobile apps and electronic health resources- health education messaging & personal health record FEATURES OF THE PCMH • Patient-centered • Comprehensive • Coordinated • Accessible • Committed to quality & safety • Substance Abuse and Mental Health Services Administration (SAMHSA) NEW YORK STATE PUBLIC HEALTH SYSTEM -New York State, Commissioner of Health, Howard Zucker, MD,JD -New York Strategic Plan: 2018-2023 https://www.health.ny.gov/commissioner/docs/strategic_plan_2018- 2023.pdf -Follow goals set by the federal government: Healthy People 20201-2030 MEDICARE AND MENAGED CARE PLANS -Federal program of health insurance for those: • Over the age of 65 • People with certain disabilities under 65 (ex. End Stage Kidney Disease) -Medicare for Seniors has multiple parts • Part A: hospital and home care • Part B: coverage for provider services, supplies • Part C: Medicare Advantage Plans • Part D: Prescription Coverage MEDICAID • Joint Federal and State program of Health Insurance based on: o Poverty Guidelines o Children, Pregnant women, Seniors, Parents and individuals with Disabilities o Residency in the state applying for benefits • Different eligibility and services covered across state lines (work requirement in some states) most recipients of Medicaid now enrolled in Managed Care Health Plans • Largest payer of nursing home and long-term care program costs OTHER TOPICS TO CONSIDER: • Affordable Care Act • Home Health Care Coverage • Group Health Insurance HEALTH SYSTEMS IN NEW YORK CITY & LONG ISLAND • Catholic Health Services of Long Island o Based in Rockville Centre o 6 Hospitals in Nassau and Suffolk Countries • Medisys o Based in Queens o 3 Hospitals (Jamaica Hospital, Flushing Hospital, Brookdale Hospital) • Montefiore Health system o Based in the Bronx and north NY o Hospitals in the Brox, Westchester and Rockland countries o 10 Hospitals (Montefiore Hospital, Montefiore Children Hospital, Jack D. Weiler Hospital, Montefiore Wakefield Hospital, Burke Rehabilitation Hospital, Montefiore Mount Vernon Hospital, Montefiore New Rochelle Hospital, Nyack Hospital, St Luke's Cornwall Hospital, White Plains Hospital) • Mount Sinai Health system o Based in Manhattan o Hospitals in Manhattan, Brookly, and Queens o 7 hospitals (Beth Israel Medical Center, Beth Israel- Brooklyn, Mount Sinai Medical Center, Mount Sinai Queens, New York Eye and Ear Infirmary, Mount Sinai West, St. Luke's Medical Center) • New York -Presbyterian Healthcare system o Based in Manhattan o Hospitals in Manhattan, Queens, Bronx, Brooklyn, Westchester County • Northwell Health o Based in Nassau Conty o 15 hospitals in Manhattan, Nassau, Queens, Staten Island, Suffolk Countries • NYU Langone o Based in all boroughs and Long island o 6 hospitals (Tisch, Kimmel, Lagnone Ortho, Hassenfeld, Children’s, Langone Brooklyn, Langone Long Island) o Multiple outpatient clinics IN CLASS ACTIVITY -You are the primary care RN working in an urban NYU ambulatory care practice with your own panel of patients. Patricia P is one of your patients… WHAT IS POPULATION HEALTH DEFINE POPULATION HEALTH MANAGEMENT (PHM) KEY TERMS AND PRINCIPLES • PHN is a model of care that address individuals’ health needs at all points along the continuum of care, including in the community setting, through participation, engagement and targeted interventions for a defined population • The goal of PHM is to maintain or improve the physical and psychosocial well-being of individuals and address health disparities through cost- effective and tailored health solutions.” IMAGINE THIS SCENARIO FOR PATIENTS: -A health care team that focuses on: • Being proactive and continuously monitoring your health • Identifying and coordinating your needs and care based on your values and preferences • Engages with you to supports your personal health goals • Connects you to social and economic resources that impact your health WHAT DETERMINES POPULATION HEALTH OUTCOMES? -As shown in the County Health Rankings (2014), Population Health Model, providing clinical care alone is not enough to improve population health outcomes -The distinguishing feature of PHM is the focus on managing this broad set of health care determinants that go beyond just clinical care -“Food is medicine” -“Housing is medicine” PHM USESE EXPANGED ROLE OF RNs • RNs managing their own patient panels as part of a team is one such enhanced role which can increase primary care capacity and value • RN value-added to the team of clinicians managing a panel of patients include use of clinical judgment to: o Interpret patient panel metrics o Identify care gaps, and o Close care gaps with implementation of complex care management, medication management, care coordination and care transitions, and supervision of unlicensed providers on the team PANEL MANAGEMENT • Panel management is a proactive approach to health care • Population refers to the panel of patients associated with a clinician or a care team • Population-based care means that the care team is concerned with the health of the entire population of its patients, not just those who come in for visits • What is a panel? • A panel is a list of patients assigned to a care team in the practice • This means that a patient will have the opportunity to receive care form the same clinician and his or her care team • The care team (e.g., a physician, a nurse, a medical assistant, and a health educator) is responsible for preventive care, disease management, and acute care for all the patients on its panel PATIENT REGISTRY; “Quality measures span four domains: patient/caregiver experience, care coordination/patient safety, preventive health, and at-risk populations.” • The registry is a database that stores patient health care information. The registry is a list of the names of all the patients of a provider or a clinic, with medical information about each patient • The registry can be searched to give feedback to a clinic and a clinician on performance measures; identify patients overdue for mammos, pap, HbA1c or LDL blood tests, eye exams, etc. • The registry can also identify patients not in control of HbA1c, LDL, or blood pressure, patients who need more coaching or more extensive planned visits with a RN or nutritionist Important Metrics • Immunizations • Vaccinations • Colorectal CA screening • Mammograph y screening • Tobacco cessatio n • Medication PHM BASICS Key Principles Steps to Implement 1. Care integration 2. Care coordination 3. Teamwork and collaboration 4. Patient engagement 5. Data analytics and HIT 6. Measure what matters 1. Develop a patient registry 2. Select a patient population/subpopulat ion 3. Assess the patient population 4. Risk stratify the patient population 5. Identify care gaps 6. Close care gaps SOME IMPORTANT QUALITY MEASURES • Colorectal Cancer Screening • Use of Spirometry Testing in the Assessment and Diagnosis of COPD • Pharmacotherapy Management of COPD Exacerbation • Controlling High Blood Pressure • Annual Monitoring for Patients on Medications • Medication Reconciliation Post-Discharge • Use of High-Risk Medications in the Elderly • Osteoporosis Management in Women Who Had a Fracture • Antidepressant Medication Management HOW TO MEASURE PHM SUCCESS? Avoid hospitalizations- increase quality of life. • Think care gaps • Preventive screenings and immunizations • Controlled chronic disease management states BRINING THINGS TOGETHER… -Overarching Goals Healthy People 2030’s overarching goals are to: • Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death • Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all • Create social, physical, and economic environments that promote attaining the full potential for health and well- being for all • Promote healthy development, healthy behaviors, and well- being across all life stages • Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all • Through education, training and advocacy, nurses emphasize the fact that every person is entitled to have their basic human needs met regardless of identity, place of residence or health • Nurses serve as public health and patient advocates, providing quality and compassionate care for patients and their families regardless of income, race, gender identity or immigration status 2021: A CALL TO ACTION • Last year in its declaration of the Year of the Nurse & Midwife, the world Health Organization called nurses “the ‘bridge’ of healthcare, a crucial link between the people of the community and the complex healthcare system.” • Additionally, the organization stated that “nurses are on the ‘front lines” of healthcare,” and as such are spearheading the goal of achieving universal health coverage and brining adequate healthcare to human beings across the globe • Given the current societal and healthcare crises sweeping the globe, it is important to consider the impact of systemic racism and health disparities on public health and advocacy efforts. A key component of patient advocacy is recognizing the health inequities that exist in our communities, and the disproportionate toll that serious conditions exact upon communities off color. POLICY, UNDERLYING HEALTH CONDITIONS AND CHRONIC DISEASE IN MINORITY COMMUNITIES • According to the CDC, the share of African-Americans among all people with the novel virus is almost twice as high as their population share. African-Americans have worse underlying health conditions in large part because they are regularly more exposed to health hazards than is the case for whites. The CDC also points out that these health disparities are not a reflection of genetic or behavioral differences. But, are the result of policies that often harm black communities • Black people are forces to contend with disproportionately high death rates for chronic health conditions including heart disease, stroke, and many cancers. Black women die from pregnancy and childbirth at three to four times the rate of white women; while black children are more than twice as likely to have asthma as white children ORGANIZATIONS MAKING A DIFFERENCE -Nearly all international and national nursing associations and organizations have an active commitment to health policy and advocacy. Some highlights include: • American Heart Association New York City • New York Organization of Nurse Executives and Leaders (NYONEL) • International and National Nursing Associations and Foundations o Sigma Theta Tau International (STTI) o The Robert Wood Johnson Foundation o American Nurses Association (ANA) o American Organization for Nursing Leadership (AONL) AMERICAN HEART ASSOCIATION • The American Heart Association’s legislative and regulatory priorities represent the best opportunities to help Americans live Longer, healthier lives. Theses include efforts to enhance, protect and restore funding for the National Institutes of Health (NIH) and secure prioritization of NIH funding for heart and stroke research AMERICAN HEART ASSOCIATION -State and Community Advocacy • AHA has state and community Government Relations staff in 50 states and many communities • Public policy advocacy is an essential strategy used by the American Heart Association and American Stroke Association to affect necessary and sustainable policy, system and environmental change. Our efforts in states and communities are focused on five major policy areas. These are: Tobacco Free, Quality Systems of Care, Healthy Eating, Active Living, and Access to Care AMERICAN NURSES ASSOCIATION (ANA) • The American Nurses Association (ANA) believes that advocacy is a pillar of nursing. Nurses instinctively advocate for their patients, in their workplaces, and in their communities; but legislative and political advocacy is no less important to advancing the profession and patient care • ANA offers the information, tools, and resources that nurses need to become effective advocates. Through championing the nursing profession, nurses give a voice to the essential role that they play in advancing access to high-quality, affordable care. with energetic participation in advocacy, every nurse can help the profession to improve and move to higher levels WMERICAN ORGANIZATION FOR NURSING LEADERSHIP (AONL) -AONL Advocacy Day • The annual AONL Advocacy Day gives nurses the opportunity to talk directly to legislators about the challenges facing their patients and their communities. Nurses from all levels and settings are encouraged to participate in Advocacy Day. • Participants in AONL Advocacy Day travel to Washington D/C/, where they take part in the following: « Access Disability Impacts Cera oa) ORY) 61 million adults in the United States live with a disability Click for state-specific information > RNAction: When nurses speak, Washington listens an a iy SAPHA oT AMERICAN PUBLIC HEALTH ASSOCIATION Far science, For action Far health Wats Twice Paling Flirting Praca Fonts Nes PublicHealth? —ssues_—— “Advocacy Periodicals Development Meetings Media ADH > BaleyStatements ant Away Policy Statements and Advocacy Health eV et scitetrd Uar Pray Stamens at ivesany ‘arsy Tet Paley Sterns AVA ie primary voles er publ hau th ae wacuey. 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POPULATION HEALTH- ETHICS IN POPULATION HEALTH ETIC AND EMIC • Terms originated in Cultural Anthropology to account for a researcher’s relationship to the population under study • As nurses we may examine our relationships to the vulnerable populations with which we work ETHIC -Outside taking in EMIC -First-hand experience -In-group knowledge ETIC VS EMIC • Etic o Outside perspective; might be overly prescriptive or unaware of the patient point-of-view and health needs; may impose unwanted or ineffective agendas and interventions due to poor understanding of group needs • Emic o In-group identity; might over-identify with patients or project one’s own experiences onto patients -SPOTLIGHT ON HOMELESSNESS- PREFERRED TERMS • “Persons who experience homelessness” • “Persons who have experienced homelessness” • “Persons living homeless” • … illness or other severe health problems • Black and Hispanic/Latinx New Yorkers are disproportionately affected by homelessness. Approximately 57 percent of heads of household in shelters are Black, 32 percent are Hispanic/Latinx, 7 percent are White, less than 1 percent are Asian-American or Native American, and 4 percent are of unknown race/ethnicity Paces - Streets People – Transitional Housing Sites: Safe Havens & Shelters Reside – Supportive Housing Sites: Scatter Site or Congregant STREETS LIVING • Street-to-home programs • “Breaking Ground” • “Manhattan Outreach Committee” -SHELTERS- Safe haven -Ethical alternative to Shelter System • No curfew • Fewer restrictions SUPPORTIVE HOUSING • Scatter site o Housed at various sites throughout the city o Limited support available • Congregant care o Tends to be more restrictive o One building housing many tenants o Support staff offices located in lobby or basement HOUSING CATEGORIES • Cat A: serious mental illness • Cat B: OMH • Cat C: <25 years old • Cat D: families • Cat E: active substance use • Cat F: sustained sobriety • Cat G: families w/HIV • Cat H: individuals w/HIV • General population: ***Bonus classification: NY 1515 homeless for 10+ Years SUPPORTIVE HOUSING -ACT Team • Helps people remain housed • 24/7 care • Continuous care (open-ended/ life-long) • Interdisciplinary treatment team PROS: PERSONALIZED RECOVERY ORIENTED SERVICES • Program for adults with Serious mental illness • Personalized recovery toward meeting life goals • Not conserdred a day program; considered a rehabilitation model with a treatment component • Addresses individualized barriers that impact patient’s life o Becoming a better parent o Pursuing an apartment o Having more friends o Having a girlfriend/boyfriend/sig.other/baefriend/theyfriend PROS COMPONENTS • Community rehabilitation & support (CRS): used to help individuals manage their mental health condition(s), restore skills, and establish or develop supports and resources • Intensive rehabilitation (IR): used to assist individuals who are ready to actively pursue a life role goal, who are at risk of losing a life role, or who are experiencing a relapse • Ongoing rehabilitation & support (ORS): use to assist individuals to manage mental health barriers that impact their ability to maintain integrated, competitive employment • Clinic treatment (CT): used to address functional barriers related to a life role HEALTH CONCERNS (ETIC PERSPECTIVE) • Adjustment disorder -> Risk for SI • Post-traumatic stress disorder • Untreated Severe Mental Illness • Addictions, harm reduction, reversal Agents • Inadequate and inconsistent medical care/ inadequate insurance coverage • No known history • Infection risk • Virus transmission • Poor nutrition • Dermatological and hygienic concerns: o Exposure to bedbugs, mites; limited access to bathing and laundering facilities PATIENT CONCERNS (EMIC PERSPECTIVE) • Where to keep belongings o “My stuff got stolen again, this time while I was sleeping” • Violence, attacks, trauma o “I don’t feel safe, ever” o “My shelter roommate assaulted me” • Independence is threatened o “If I move in there, are the staff going to be watching me and bugging me all the time?” • Addiction culture and social pressure o “Some people use your addictions to support their own.” • Losing or returning with dependents and loved ones o Children, spouses, animals o “I don’t want to go indoors if it means I have to leave my bird behind.” RESISTING ENGAGEMENT • Legacy of poor treatment o “I don’t want to be drugged up”/ overmedicated/chemically restrained • Legacy of Abandonment o Sometimes guarded, not readily trusting of new providers o “Every time I open up to someone they leave” • Skepticism o “How can you help me if you haven’t been in my shoes?” • Documentation concerns TREATMENT OPTIONS/SOLUTIONS • Long acting injectables: improve serious mental illness outcomes • Safe havens: prioritize independence • Emotional support animals • Case managers: manage follow-up/ continuity, insurance coverage, good rx coupons, co-pay funding • Housing application: application to secure housing • Methadone/suboxone treatment programs • Narcan training/harm reduction training • Assertive community treatment (ACT) Team: provides community-based supports to help people remain housed • PROS: integrates rehabilitation, treatment, and support services for people with serious mental illness