Public Health Nursing Roles for Addressing Diabetes in the American Indian Population in Kent County, Michigan Amy K. Johns Ferris State University
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Abstract This is a paper written for a Bachelor of Science in Nursing class regarding public health and community nursing. It examines two roles, direct-care public health nurse and leader/manager public health nurse in the context of a community change project regarding primary educative prevention for diabetes in the American Indian population in Kent, County, Michigan. It examines the eight domains of public health nursing and their specific focus in each role. It discusses the authors specific qualities regarding each role.
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Public Health Nursing Roles for Addressing Diabetes in the American Indian Population in Kent County, Michigan Diabetes is a huge and growing problem worldwide. The International Diabetes Federation (2013) estimates that 366 million people have been diagnosed with diabetes in the year 2011 and they project that that number will grow to 522 million by the year 2030. It is also estimated that global expenditure for diabetes was 465 billion US dollars, or 11% of all health care expenditures for adults 20-79 years of age. In the United States in 2010, 25.8 million people or 8.3 % of the population were affected by diabetes (Centers for Disease Control, 2011). Rates for minority/ethnic populations in the United States are higher. This includes the American Indian (AI) population. According to the Centers for Disease Control (CDC) (2011), 16.1% of the total adult population of AIs have diagnosed diabetes. This is variable by region, running as high as 33.5% of adult AIs in southern Arizona (CDC, 2011). Rates of diabetes for American Indians in Michigan are also higher than national benchmarks for white people. An American Indian in the US is twice as likely to have diabetes as a white person (CDC, 2011). A project entailing an analysis of the diabetes rate, existing resources, and plan for future interventions for a United States American Indian population (in Kent County, Michigan) from a public health perspective is being undertaken for a Bachelor of Science in Nursing Community Nursing class. Direct-care and leadership/management roles needed to carry out this assignment will be explored in this paper. The American Nurses Association (ANA) Standards of Professional Practice for Public Health Nursing will be discussed in the context of these roles. Leadership, personal, and professional characteristics in the nurse that best fulfill this position will be discussed, as well as characteristics that both suit and present challenges for this nurse particular. PUBLIC HEALTH NURSING ROLES 4
Public Health Nursing Roles State and County Health Departments are major population-based health care resources for chronic diseases, especially among disparate populations. There are many roles for public health nurses, both in direct client care and leadership/management positions. Direct-Care Role Type II or adult-onset diabetes is correlated with obesity, diet, and lack of exercise and is a preventable disease (CDC, 2011). One role for a direct-care nurse is that of educator or counselor of families or individuals. Public health nurses as counselors and educators can help guide people at all three levels of prevention: primary, secondary, and tertiary. Ideally, education resources aimed at fostering healthy eating, weight control and exercise would prevent the development of type II diabetes. This would save millions of healthcare dollars and improve the quality of life for millions of people. The Kent County, Michigan Health Department has two departments that incorporate direct-care, public health nursing that are being explored for our assignment. These are departments in which nurse educators and counselors who provide primary diabetes prevention education. They are the departments of Administrative Health and Community Nursing. The Administrative Health Division is responsible for Communicable Disease/Epidemiology, Health Education and Promotion, and the Obesity Initiative (County of Kent, 2013). All of these branches are involved prevention and treatment of diabetes. Our group has focused its interventions on the education of American Indian adolescents about the disease of diabetes, its implications on health and its impact on the AI population. We are using evidence-based research regarding effective programs used specifically for AI youth (Brown et. al. 2010). We are also using research ideas from an adolescent outreach program called Empower U (Dowdy, PUBLIC HEALTH NURSING ROLES 5
et. al., 2013). We will also provide education and counseling about obesity prevention, nutrition and exercise and their roles in the prevention of diabetes. A direct-care nurse in the position of educator in the Health Education and Promotion branch of the Administrative Division of the Kent County Health Department would be ideal. Leadership/Management Role Multi-disciplinary collaboration is crucial for effective intervention that reaches the most members of the desired population of a public health undertaking. Our project is aimed at American Indian adolescents in Kent County, Michigan. We would be benefitted by leadership that had access to many other community institutions, leaders, and funding. It is also crucial that the Office of the Governor and the State of Michigan be on board with the philosophy of preventative care, community health, and public health nursing. The CDC, the Association of State and Territorial Health Officers, the National Association of County and City Health Officials, and the Association of Community Health Nursing Educators have produced a statement that promotes a position equivalent to a Chief Nursing Officer. Public health nurse directors and chief nurses in state health departments are the key to a strong public health nursing workforce vital to maximizing public health nursings contribution to healthy populations and healthy communities (Association of State and Territorial Directors of Nursing, 2008). Michigan has this position as of 2008 (RN-AIM, n.d.). This is key to the success of public health nursing programs. Specific to our project, having a leader in the position of Administrative Health Officer for Kent County would be highly beneficial. This position oversees the establishment of strategic direction and overall goals for the Health Department (County of Kent, 2013). This would provide strategic access to other collaborative members of the county government as well PUBLIC HEALTH NURSING ROLES 6
as the Health Department. A public health nurse in the role of Administrative Health Officer would ensure that nursing philosophy of healthy mind-body-spirit would be carried into county government. Scope and Standards of Practice for Public Health Nursing Gail Harkness, DrPH, RN, FAAN writes in Community and Public Health Nursing (p. 9), that there are eight domains of qualifications specific to Public Health Nursing Practice set forth by the American Nurses Association. These are the standards of practice and leadership qualities that are present in a competent public health nurse (Harkness, 2012). They are: Analytic assessment skills Policy development and program planning skills Communication skills Cultural competency skills Community dimensions of practice skills Basic public health science skills Financial planning and management skills Leadership and systems thinking skills Other qualities that would be beneficial specific to our project would be experience working with adolescents, having a rapport with young people, cultural openness, and knowledge of the American Indian culture of Kent County. Also, knowledge of the condition of diabetes in American Indians with regard to social determinants of health: a broad knowledge base of all aspects of lifestyle, health, traditions, socioeconomic implications, etc. (Mitchell, F., 2012). All of these qualities and competencies are important to both the direct-care and leader/manager public health nursing roles identified here. PUBLIC HEALTH NURSING ROLES 7
Analysis of Roles All eight domains specified are important to all public health nursing roles. However, analytic assessment, communication, cultural competency and basic public health science are crucial skills to be developed by the direct-care public health nurse. Knowledge of American Indian culture and communication skills with adolescents are competencies specific to our project. Policy development and programming, community dimensions of practice, financial planning and management, and leadership and systems thinking are skills specific to the leader/manager role. Financial planning and policy development are elements that the leader/manager may need knowledge of to ensure that the goals and mission of the Health Department are continually heeded and funded by our State government officials. Knowledge of politics at the local and state level is crucial to make sure the voices of public health nurses and those they serve are heard. Specific Skills and Competencies of This Nurse With regard to my competencies and skills and how they might be suited to each role, I am a new nurse with two years of experience in an acute-care, hospital setting. This class and a class called Population-Based Health Promotion have been my only exposure and experience with public health nursing. I am lacking in the competencies of policy development and program planning. I also have no experience with financial systems or community dimensions of practice. I have limited leadership experience; however, I am in several leadership roles within my bachelors degree program and as the Chair Elect of the Unit Action Council of the unit of the hospital where I work. I have excellent written and verbal communication skills and have been told that I am extremely perceptive and empathetic. I get very good feedback from my patients, my manager and my coworkers. I am a very good educator and take pride in our role as PUBLIC HEALTH NURSING ROLES 8
one of the best teaching floors in a teaching hospital. With experience and education in public health policy and practice, I could be an effective leader of healthy community change.
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References Association of State and Territorial Directors of Nursing, (2008). Every State Health Department Needs a Public Health Nurse Leader. [Brochure]. Retrieved from http://www.phnurse.org/docs/Every_State_Health_Dept._Needs_a_PHN_Leader_2008.p df Brown, B.D., Harris, K.J., Harris, J.L., Parker, M., Ricci, C., & Noonan, C., (2010). Translating the Diabetes Prevention Program for Northern Plains Indian Youth Through Community- Based Participitory Research Methods. Diabetes Educ. ,36(6), 924-935. doi: 10.1177/0145721710382582 Centers for Disease Control and Prevention, (2011). National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States. [Webpage]. Retrieved from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf County of Kent, (2013). Health Department. From accessKent.com. [Website]. Retrieved from https://www.accesskent.com/Health/health_department.htm Dowdy, S., Alvarado, M., Atieno, O., Barker, S., Barrett, S., Carlton, A., Williamson, L., (2013). Empower U: Effectiveness of an Adolescent Outreach and Prevention Program With Sixth-Grade Boys and Girls: A Pilot Study. Journal of Pediatric Nursing, 28, 77- 84. Harkness, G.A., (2012). Community and Public Health Nursing: Present, Past, and Future. In Harkness, G.A., & DeMarco, R.F., (Eds.). Community and Public Health Nursing. Philadelphia, PA: Lippincott Williams & Wilkins. International Diabetes Federation, (2013). The Global Burden. [Webpage]. Retrieved from http://www.idf.org/diabetesatlas/5e/the-global-burden PUBLIC HEALTH NURSING ROLES 10
Mitchell, F., (2012. Reframing Diabetes in American Indian Communities: A Social Determinents of Health Perspective. National Association of Social Workers. doi: 10.1093/hsw/hls013 RN-AIM, (n.d.). Maintaining the Position of Chief Nurse Executive: Leadership for Health Care in Michigan. [Webpage]. Retrieved from http://www.micomon.org/files/2009_11_25/Maintaining_the_Position_of_Chief_Nurse.p df