HEALTH NURSING (2011)
Tier 2 Community Based, Population Focused
1. Analytic and Assessment Skills
Assesses health status of populations and related determinants of health and illness. Partners with populations, health professionals, and other stakeholders to attach meaning to collected data.
Develops PHN diagnoses for individuals, families, communities, and populations. Uses a synthesis of nursing, public health, and system science/theory when characterizing population-level health risks. Assures that assessments identify population assets and needs, values and beliefs, resources, and relevant environmental factors. Derives population diagnoses and priorities based on assessment data, including input from populations.
Utilizes a wide variety of relevant variables to measure health conditions for a community or population.
Develops a data collection plan using models and principles of epidemiology, demography, and biostatistics, as well as social, behavioral, and natural sciences to collect quantitative and qualitative data on a community or population.
Uses methods and instruments for collecting valid and reliable quantitative and qualitative data.
Uses multiple methods and sources when collecting and analyzing data for a comprehensive community/population assessment. Assures that assessments are documented and interpreted in terms that are understandable to all who were involved in the process, including communities.
Critiques validity, reliability, and comparability of data collected for communities/populations.
Identifies gaps and redundancies in data sources used in a comprehensive community/population assessment. Examines the effect of gaps in data on PH practice/program planning.
Assures the application of ethical, legal, and policy principles in the collection, maintenance, use, and dissemination of data and information.
Synthesizes qualitative and quantitative data during analysis for a comprehensive community/population assessment. Uses various data collection methods and qualitative and quantitative data sources to conduct a comprehensive, community/population assessment.
Incorporates an ecological perspective when analyzing data from a comprehensive community/population assessment. Partners with groups, communities, populations, health professionals, and stakeholders to review and evaluate data collected.
Utilizes information technology effectively to collect, analyze, store, and retrieve data related to care of communities and populations.
Practices evidence-based PHN to promote health of communities and populations.
Collects data related to SDH and community resources to plan for community-oriented and population-level programs. Analyzes those data.
Incorporates the results of those analyses into program planning.
2. Policy Development/Program Planning Skills
Identifies valid and reliable data relevant to health policies targeted to communities and populations. Conducts and uses policy analysis to address specific public health issues.
Plans population-level interventions guided by relevant models and research findings.
Conducts and uses policy analysis to address public health issues. Incorporates a wide range of policy options into the planning and delivery of health services and interventions to groups, communities, and populations.
Plans population-level interventions guided by relevant theories, concepts, models, policies, and evidence. Uses planning models, epidemiology, and other analytical methods in evaluating population-level interventions. Critiques the evidence for population-level interventions. Conducts and uses policy analysis to address specific public health issues.
Selects an appropriate method of decision analysis for an issue relevant to an identified group, community, or population. Uses planning models, epidemiology, and other analytical methods in the development and implementation of population-level interventions.
Manages the delivery of community/population-based health services.
Evaluates and ensures compliance with public health laws and regulations.
Develops plans to implement programs and organizational policies. Works as part of an interdisciplinary team to implement relevant policies into community/population-level interventions.
Manages the implementation of organizational policies and programs for areas of responsibility.
Designs an evaluation plan that addresses multiple variables, includes both process and outcome measures, and uses multiple data collection methods.
Conducts evaluation of care delivery to communities and populations served by the organization. Provides feedback on the organization’s quality improvement program. Establishes methods to utilize technology to collect data to monitor and evaluate the quality and effectiveness of programs for communities and populations.
Identifies a variety of sources and methods to access public health information for a community/population. Utilizes technology to collect DISPLAY 15–
1Quad Council Core Competencies of Public Health Nursing (2011) (Continued)data to monitor and evaluate the quality and effectiveness of programs for populations.
Develops quality improvement indicators and core measures as part of the process to improve public health programs and services. Utilizes quality improvement indicators and core measures as part of the process to improve public health programs and services.
3. Communication Skills
Assesses the health literacy of communities/ populations served.
Communicates effectively in writing, orally, and electronically.
Communications are characterized by critical thinking and complex decision- making.
Solicits input from community/population members and stakeholders when planning health care programs.
Utilizes a variety of methods to disseminate public health information tailored to communities/populations.
Demonstrates presentation of targeted health information and outcomes of evidence-based practice (EBP) to multiple audiences, including community and professional groups.
Communicates effectively with community groups, partners, and interprofessional teams.
Articulates role of public health within the overall health system to internal and external audiences.
4. Cultural Competency Skills
Utilizes social and ecological determinants of health to develop culturally responsive interventions with communities and populations.
Uses epidemiological data, concepts, and other evidence to analyze the SDH when developing and tailoring population-level health services. Applies multiple methods and sources of information technology to better understand the impact of SDH on communities and populations.
Plans health services to meet the cultural needs of diverse communities and populations.
Explains the interplay of multiple forces contributing to cultural diversity.
Serves as an advocate to build a diverse public health workforce.
Uses evidence and awareness of cultural models to tailor interventions to diverse populations. Evaluates current population health programs for evidence of cultural tailoring. Evaluates staff development needs related to cultural competency.
Uses evidence and cultural models to tailor program level interventions.
5. Community Dimensions of Practice Skills
Utilizes an ecological perspective in health assessment, planning, and interventions with communities and populations.
Provides population health expertise for community-based participatory research (CBPR) teams.
Identifies need for community involvement and partners to create community groups/coalitions.
Identifies mechanisms for enhancing collaboration among stakeholders in population-focused health interventions. Develops partnerships with key stakeholders and groups.
Partners effectively with key stakeholders and groups in care delivery to communities/populations.
Identifies areas for community involvement in agency programs and initiatives.
Critiques the evidence on approaches to fostering community partnerships and involvement. Uses evidence-based guidelines and effective group processes to partner with community members and groups.
Explains to community groups and partners the role of government and the private and nonprofit sectors in the delivery of community health services.
Utilizes community assets and resources to promote and deliver care to communities/populations.
Uses input from a variety of community/aggregate stakeholders in development of public health programs and services.
Advocates for public health policies, programs, and resources that better serve populations.
6. Basic Public Health Sciences Skills
Utilizes public health and nursing science to practice at population and community level.
Describes the influence of sentinel events on current PHN practice.
Uses EBP to assure population-level programs contribute to meeting core public health functions and the 10 essential services.
Uses descriptive and analytical methods and public health sciences to design, implement, and evaluate interventions at community and population level.
Synthesizes research across disciplines related to public health concerns and population-level interventions.
Identifies gaps in the scientific evidence related to public health issues, concerns, and population-level interventions.
Identifies a wide variety of sources and methods to access public health information, for example, geographic information system (GIS) mapping.
Identifies gaps and inconsistencies in research evidence for practice.
Incorporates the requirements of patient confidentiality, human subject protection, and research ethics into data collection and processing.
Disseminates theory-guided and/or EBP outcomes in peer-reviewed journals and national level meetings. Facilitates research projects with organizations.
7. Financial Management and Planning Skills
Collaborates with relevant public and/or private systems for managing programs in public health.
Supervises the operations of health programs within federal, state, tribal, and local public health agencies.
Develops partnerships with communities and agencies within federal, state, tribal, and local levels of government that have authority over public health situations, such as emergency preparedness.
Implements the judicial and operational procedures of the governing body and/or administrative unit designated with oversight of public health organizational operations.
Develops a programmatic budget.
Manages care delivery to communities/populations within current and forecasted budget constraints.
Develops strategies for determining budget priorities based on financial input from federal, state, tribal, and local sources.
Assesses impact of organizational budget priorities on PHN programs and practice. Establishes organization PHN resource priorities that assure effective PHN practice.
Designs evaluation plans for population-focused programs. Implements evaluation plans for population-focused programs.
Leads revisions to population-focused programs based on formative and summative evaluation results.
Develops proposals for funding from external sources.
Applies basic human relations and conflict management skills in interactions with direct reports, other professionals, and health care team members.
Identifies opportunities to use health care technologies and informatics to improve public health program and business operations. Incorporates health care technology and informatics to improve public health program and business operations.
Assists in the development of contracts and other agreements for the provision of services.
Describes how cost-effectiveness, cost–benefit, and cost–utility analyses affect programmatic prioritization and decision-making. Employs cost-effectiveness, cost–benefit, and cost–utility analyses for programmatic prioritization and decision-making.
Participates in implementation and evaluation of performance management systems.
8. Leadership and Systems Thinking Skills
Addresses ethical issues related to the PHN care of communities/populations.
Applies system theory to PHN practice with communities and populations.
Leads team and community partners in identifying vision, values, and principles for community action.
Analyzes internal and external factors that may impact the delivery of essential public health services. Implements strategies to assure quality, collaboration, and coordination in delivery of PHN services.
Leads interprofessional team and organizational learning opportunities.
Provides leadership in staff development.
Implements opportunities to mentor, advise, coach, and develop peers, direct reports, and other members of the public health workforce.
Uses evidence-based models to design and implement quality initiatives.
Establishes indicators to monitor organizational performance.
Adapts program delivery to communities/populations in consideration of changes in the public health system and larger social, political, and economic environment. Assesses outcomes of current health policy relevant to public health/PHN practice.
Note: Tier 1 competencies cover generalist PHNs, and tier 2 competencies cover PHNs with program implementation and supervisory/management duties that may include clinical services, home visiting, and community-based and population- focused programs. Tier 3 competencies refer to senior management or executive level PHNs in administrative/leadership roles at public health agencies or organizations.
Refer to the complete document for a total list of competencies at all three levels.
From Swider, S., Krothe, J., Reyes, D., & Cravetz, M. (2013). The Quad Council practice competencies for public health nursing (pp. 525–536). Public Health Nursing, 30(6), 519–536. Used with permission.
Deliberative
The nursing process, like the research process in EBP (evidence-based practice), is deliberative—purposefully, rationally, and carefully thought out. It requires the use of sound judgment that is based on adequate information. Community health nurses often practice in situations that demand the ability to think independently and make difficult decisions. Furthermore, thoughtful, deliberative problem solving is a necessary skill for working with the community health team to address the needs and problems of aggregates in the community. The nursing process is a decision-making tool to facilitate these determinations.
Adaptable
The nursing process is adaptable. Its dynamic nature enables the community health nurse to adjust appropriately to each situation and to be flexible in applying the process to aggregate health needs. Furthermore, its flexibility is a reminder to the nurse that each client group and each community situation is unique. The nursing process must be applied specifically to the individual situation and group of people. Based on assessment and sound planning, the nurse adapts and tailors services to meet the identified needs of each community client group.
Cyclical
The nursing process is cyclical and in constant progression. Steps are repeated over and over in the nurse–aggregate client relationship. The nurse engages in continual interaction, data collection, analysis, intervention, and evaluation. As interactions between nurse and client group continue, various steps in the process overlap with one another and are used simultaneously. The cyclic nature of the nursing process enables the nurse to engage in a constant information feedback loop: The information gathered and lessons learned at each step of the process promote greater understanding of the group being served, the most effective way to provide quality services, and the best methods of raising this group’s level of health.
Client Focused
The nursing process is client focused; it is used for and with clients. Community health nurses use the nursing process for the express purpose of addressing the health of populations. They are helping aggregate clients, directly or indirectly, to achieve and maintain health. Clients as total systems—whether groups, populations, or communities—
are the targets of the PHN’s nursing process (ANA, 2013).
Interactive
The nursing process is interactive, in that nurse and clients are engaged in a process of ongoing interpersonal communication. Giving and receiving accurate information is necessary to promote understanding between nurse and clients and to foster effective use of the nursing process. Furthermore, because of the movement toward informed use of health care, demands for clients’ rights and the concept of self-care have gained emphasis. Client groups and community health nurses have increasingly joined forces to assume responsibility for promoting community health. The nurse–aggregate client relationship can and should be a partnership, a shared experience by professionals (nurses and others) and client groups (Tucker, Arthur, Roncoroni, Wall, & Sanchez, 2015).
Need Oriented
The nursing process is need oriented. A long association with problem solving has tended to limit the focus of the nursing process to the correction of existing problems. Although problem solving is certainly an appropriate use of the nursing process, the community health nurse can also use the nursing process to anticipate client needs and prevent problems. The nurse should think of nursing diagnoses as ranging from health problem identification to primary prevention and health promotion opportunities. This focus is needed if the goals of community health—to protect, promote, and restore the people’s health—are to be realized.
Interacting with the Community
All steps of the nursing process depend on interaction, reciprocal exchange, and influence among people. Although nurse–client interaction is often an implied or assumed element in the process, it is an essential first consideration for community health nursing (see Chapter 10 for more details). Listening to a group of elderly people, teaching a class of expectant mothers, lobbying in the legislature for the poor, working with parents to set up a dental screening program for children—all these involve relationships, and relationships require interaction. Mutual give and take between nurse, clients, and community stakeholders—
whether a family, a group of mothers on a Native American reservation, or representatives from resource agencies within the community—is an expected and much needed skill that should be integrated throughout the nursing process (see Fig. 15–6).
FIGURE 15–6 NURSING process components. Nurse–client interaction, a preamble structure, forms the core of the process. As a nurse and client maintain a reciprocal exchange of information and trust through interaction, they can effectively assess client needs, diagnose needs, and plan, implement, and evaluate care.
Need for Communication
When a community health nurse initially contacts a group of community leaders, for example, any information the nurse may have in advance can give only partial clues to that group’s needs and wants. Unless everyone involved talks and listens, the steps of the nursing process will go awry (LeBan, 2011). PHNs can serve as effective liaisons—
facilitating communication between stakeholders and clients to ensure that health needs both identified and adequately addressed (University of Michigan Center of Excellence in Public Health Workforce Studies, 2013).
Interaction and Effective Communication
Through open and honest sharing, the nurse (and others on the health team) will begin to develop trust and establish lines of effective communication. For instance, the nurse explains who he is and why he is there. The nurse encourages the group members to talk about themselves. Nurse and group members together discuss their relationship and clarify the desired nature of that alliance (Pavlish & Pharris, 2012). Does the group want help to identify and work on its health needs? Would its members like this nurse to continue regular contacts? What will their respective roles be? Effective communication, as a part of interaction, is essential to develop understanding and facilitate a free exchange of information between nurse and client.
Interaction is Reciprocal
Sharing of information, ideas, feelings, concerns, and self goes both ways. Nurses must avoid the temptation either to do all the talking or merely to listen while a few group members monopolize the conversation (Rost & Wilson, 2013). A dynamic exchange must exist between two systems. The community health nurse (and other collaborating health professionals) represents one system and the client group represents the other. Health care professionals tend to prioritize based on their own perspective and many times neglect to take the clients’ wishes into account. Whether the client is a parent group, a homeless population, or an entire community, this exchange involves a two-way sharing between the nurse and client group. The key elements of interaction are mutuality and cooperation.
Consider the following example: Members of a disadvantaged community met for several weeks at a community center to discuss disease management, physical activity, and healthy diets. After their agreed-upon goals had been accomplished, the nurse wondered whether further meetings were needed. After several discussions, the residents verbalized concern about unsafe conditions within the neighborhood that limited physical activity of the residents and the lack of fresh food availability within the community. These external conditions would limit the residents’ ability to adopt the healthy behaviors they had learned in the group. The nurse initially felt unprepared to address these issues, but after consulting with other support agencies within the community, she realized that resources were available and was able to work with community members and local agencies to develop a feasible physical activity plan for residents. Engagement with community members and communication were the first step in reapplying the nursing process and allowed goals for the group to be accomplished.
Interaction Paves the Way for a Helping Relationship
As nurse and client interact, each learns about the other. A test period occurs before trust can be fully established (Summach, 2011). For the female school nurse working with