Chapter 2-page 1

Chapter 2 Responses to Critical Thinking Activities

  1. How would you decide if the organizations in your community work together as a public health system? How would you identify what untapped resources could be mobilized to enhance the community’s health status?

Often, public health nurses have observed whether or not local organizations are working together to meet the needs of the community. What do you see in your community? Are clients referred from one agency to another? Do they provide feedback to one another about their connections? Are projects shared to maximize the community resources? Are there successful initiatives, such as Turning Point or community-based participatory research, at work in the community?

Evidence of collaboration, or the lack of it, can be found through both informal and formal assessment mechanisms. In carrying out this core public health function, a community needs assessment may focus broadly, examining the community using the geopolitical boundaries. A targeted assessment may look more narrowly at whether the community meets the health needs of a specific population. We make assumptions, based on the results of the assessment, if the community is working as a system. Do the organizations collaborate to assess needs, develop solutions, implement strategies to meet those needs, and finally, evaluate the outcomes of the community efforts? The National Public Health Performance Standards Program (NPHPSP) provides a formal, partnership-oriented assessment of the local health system by convening a variety of organizations and community groups to carry out the community assessment. The result of this assessment will demonstrate to what extent the community is working together to meet health needs. Other tools, such as the Partnership Self-Assessment Tool, may be used to examine the benefits, drawbacks, and overall satisfaction with community partnerships.

The NPHPS assessment also provides data for determining whether there are barriers to personal and population health services. What resources are not available to the community? What resources are available, but not accessible to the populations who need them? What resources are not acceptable to the community and are underutilized? This effort engages community partners in the assessment, gap analysis and ongoing discussion of health needs. Partners can then work to fill the void that exists, as they effectively using the strengths of the community to meet health needs.

  1. How would using the ecological model of health shape your approach to assuring the conditions in which people can be healthy?

The ecological model of health provides a broad multidimensional framework for understanding health. By considering a variety of factors, such as the physical, biological, behavioral, social and environmental, you would adopt a similarly broad approach to assuring conditions in which people can be healthy. In dealing with the growing problem of obesity, for example, you would begin by examining the literature to identify the factors that have been associated with this issue, bring together community partners to address the problem and the literature, and then assess the biological, physical, social, and environmental elements in the community. Community partners would actively participate in the process, making sure that the methods used are culturally appropriate and relevant to the community. Once data are collected and analyzed, partners would be instrumental in designing community interventions and evaluating their success.

  1. Your agency has received $50,000 from a local philanthropic group to fund a teen clinic. How will you decide what services to provide? What process will you use?

In considering what services to offer, it is imperative that you engage partners in the community before you begin the process. If, prior to the funding, community-wide resources have been examined and local adolescent needs have been identified, community partners will have a basis on which to make decisions about the services needed. Knowing what services are needed is just the first step, however. Those services must be provided in a way that is acceptable and accessible to the teens. When will you offer the services? How will they be offered? What strategies will the community use to make the services known to the target group? All of these questions should be answered during the community partnership process. If the community was engaged prior to the funding, some of these questions may have been answered. If not, they should be answered prior to moving forward. By engaging the appropriate community groups, you will support a system-wide approach that encourages collaboration and sets the stage for future endeavors.

  1. While studying for an exam, a student peer questions the value of the core public health functions, which he thinks are too broad to be useful to public health nurses. How will you respond?

The core public health functions are a broad framework that gives direction to the many activities of public health. The breadth of this framework should not be a detriment, however, as the functions of assessment, policy development, and assurance become the lens through which we view all of the activities of public health. Originally defined as directing governmental public health, the functions also provide a way for public health nurses and communities to think about how they will support healthy people in healthy communities. The function of assessment provides the evidence for communities to decide on the needs and resources for promoting a healthy community. Gaps, identified through the process, challenge communities to think creatively about meeting needs in times of constrained budgets. Policy development requires political will, as communities develop and enforce laws and regulations that support health. Lastly, assurance takes on a community-wide emphasis, as partners work together to ensure that personal and population health is facilitated. Even though the functions are broad, they remind the public health system of the means to a healthy community. Public health nurses, through their close connections with the people and organizations in their communities, use these core functions, in conjunction with the essential services and public health nursing competencies, to guide their practice in the community, whether local, state, or national.

  1. In a time of constrained resources, how will you justify the resources needed to develop and sustain community partnerships within the public health system?

We are not likely to see a future without fiscal restraint, but the question of how to justify the time, and associated cost, to sustain a community partnership is one that assumes that partnership is an option, rather than the way to accomplish the goal of healthy people in a healthy community. Partnership becomes the process of identifying the specific goals, needs, and means to meet those needs at the local, state, and national level. One need only look to recent health challenges, such as Hurricane Katrina, to recognize the cost of absent or ineffective partnerships. The ecological model, viewed in the context of the public health system rather than a constellation of individual organizations working alone, demands a different approach to meeting health needs. If health is dependent on many factors, included among those social, physical, and environmental, then no one organization can do what it takes to produce the conditions that would assure health. When community partners work together to identify the strengths and weaknesses of the system, as well as the duplication of efforts and gaps in what services exist, resources can be maximized. Even though there is a cost to the individual agencies, partnership becomes the only reasonable way to get the job done, as it is the community, not any one group that works to support the health of its members.

  1. A community liaison to the state legislature is meeting with your state delegate to discuss health issues and has asked you to develop talking points about the public health nursing shortage in your state. He would also like you to include potential solutions in your points. What will you address and why?

This is an opportunity to educate your community liaison and local delegate, as well as to provide policy guidance through your response. First, it is important for you to consider some fundamental information about public health nurses in your state, as you will want to provide accurate data about the PHN population as well as the scope of the shortage. What does the PHN cohort look like in age, diversity, educational preparation, and experience? How many positions are unfilled? Are those position vacancies in particular settings or geographic locations? Having basic knowledge of the nature of the shortage will provide direction to the solutions that may prove successful. In preparing the talking points, you should consider a number of factors. Keep the points brief, preferably not more than one page, and focused on the major issues in your state. Provide evidence to support the points, whenever possible. If you are unable to find evidence in the literature and have the time to do so, contact public health and public health nursing organizations to see what unpublished data are available. Your solutions should provide a number of options, addressing the solutions that are balanced in terms of economics, political considerations, and the profile of your state. Enlist your local, state, and national professional nursing organizations in this effort. Often, they have developed talking points for the specific issue you need to address. Box 2-11 provides a variety of potential solutions for the public health nursing shortage.