Jessica Ochs; Sherry L. Roper; Susan M. Schwartz

Learning Outcomes

By the end of this section, you should be able to:

35.3.1 Explain the importance of population health in nursing education and practice.
35.3.2 Discuss ways to transform nursing practice to provide diverse populations safe, quality, and equitable care.
35.3.3 Describe how nurses may lead change to advance health across the continuum from public health prevention to disease management of populations.
35.3.4 Discuss the key to achieving positive health outcomes.

The nursing workforce must be prepared to rise to the challenge of adapting to changing health care and social support systems. With the increasing demand for nurses and the need for diverse and intensive nursing care across multiple settings, nurses must be equipped to address the negative impacts of social determinants of health on well-being (NASEM, 2021). The American Association of Colleges of Nurses (AACN) recognizes the importance of population health in nursing education and practice. AACN promotes and supports the integration of population health concepts and competencies into nursing curricula to prepare nurses to address the health needs of diverse populations. According to AACN (2021a), population care requires proficiency in six core areas as outlined in Table 35.6.

Competency	Proficiency
Manage population health	Define a target population, including its functional and problem-solving capabilities, throughout the continuum of care. Assess population health data. Assess the community’s priorities and the affected clinical population. Compare and contrast local, regional, national, and global benchmarks to identify health population health patterns. Apply an understanding of the public health system and its interfaces with clinical health care in addressing population health needs. Develop an action plan to meet an identified need(s), including evaluation methods. Participate in the implementation of sociocultural and linguistically responsive interventions. Describe general principles and practices for the clinical management of populations across the age continuum. Identify ethical principles to protect the health and safety of diverse populations.
Engage in effective partnerships	Engage with other health professionals to address population health issues. Demonstrate effective collaboration and mutual accountability with relevant parties. Use culturally and linguistically responsive communication strategies.
Consider the socioeconomic impact of the delivery of health care	Describe access and equity implications of proposed intervention(s). Prioritize safe, effective, and efficient client-focused and community action plans in the context of available resources.
Advance equitable population health policy	Describe policy development processes. Describe the impact of policies on population outcomes, including social justice and health equity. Identify the best evidence to support policy development. Propose modifications to or development of policy based on population findings. Develop an awareness of the interconnectedness of population health across borders.
Demonstrate advocacy strategies	Articulate a need for change. Describe the intent of the proposed change. Define interested parties(stakeholders), including members of the community and clinical populations, and their level of influence Implement messaging strategies appropriate to the audience and other interested parties. Evaluate the effectiveness of advocacy actions.
Advance preparedness to protect population health during disasters and public health emergencies	Identify changes in conditions that might indicate a disaster or public health emergency. Understand the impact of climate change on environmental and population health. Describe the health and safety hazards of disasters and public health emergencies. Describe the principles and methods regarding personal safety measures, including personal protective equipment (PPE). Implement infection control measures and proper use of personal protective equipment.

Table 35.6 The Six Core Areas of Population Health Proficiency (See AACN, 2021a.)

Population care requires the nurse to be prepared to promote health and prevent disease across the health care continuum, including public health, community health, acute care, ambulatory care, and long-term care. Population health also encompasses collaborative activities among all relevant individuals and organizations involved in care, including clients and communities, to improve a population’s health status (AACN, 2021a).

To deliver safe, equitable, and high-quality care to diverse client populations, nursing practice must prioritize a holistic approach that considers clients in the context of their families and communities. This involves recognizing how social, political, and economic factors impact health, focusing on what is most essential for well-being, fostering a compassionate and healing relationship, and always upholding personal dignity, choice, and meaning (AACN, 2021a).

Transforming Nursing Practice

The Future of Nursing 2020–2030 report by the National Academies of Sciences, Engineering, and Medicine (2021) has identified several crucial areas where the nursing profession must improve to overcome the challenges of the next decade. These areas include the nursing workforce, leadership, nursing education, nurse well-being, emergency preparedness and response, and the nursing profession’s responsibilities concerning the determinants of health at both the structural and individual levels. Table 35.7 highlights the obstacles that need to be addressed to achieve health equity in the next decade. The ultimate goal is to achieve health equity in the United States, which can be accomplished by strengthening nursing capacity and expertise.

Area for Improvement	Challenges
Addressing systematic issues	Systemic issues such as poverty, discrimination, and unequal distribution of resources can hinder progress toward health equity. Addressing these structural barriers is complex and requires policy changes. Disparities in health care access and outcomes, often linked to socioeconomic factors, remain significant challenges. Closing these gaps necessitates systemic changes and increased resources. Socioeconomic disparities in health information access and health literacy can impede clients’ ability to make informed decisions about their care. Efforts should be made to bridge this gap. Access to technology and health care infrastructure can be limited in certain areas, hindering the adoption of telehealth and other advancements in health care delivery. Bias and discrimination within health care systems can affect clients’ quality of care. Efforts to combat bias and promote culturally competent care are essential.
Lifting barriers to expand the contributions of nursing	A shortage of health care professionals, including nurses, hinders achieving health equity. Addressing this requires investments in education, training, and incentives to retain nurses in underserved areas. Twenty-seven states restrict practice for advanced practice nurses (APRNs), limiting care for complex needs. There is a need to eliminate state-level regulations and grant full practice authority to nurse practitioners. Institutional barriers limit APRNs, RNs, and LPNs from practicing to their full education and training.
Designing better payment models	Current payment systems need improvement to address social needs and promote health equity. Health care organizations can adopt new payment models to address social needs and drive forward health equity.
Strengthening nursing education	Nursing students must have the necessary knowledge and skills to promote health equity, reduce health inequalities, and improve the population’s overall well-being. This can be achieved through coursework and hands-on learning experiences that expose them to different care environments, such as community settings (e.g., schools, workplaces, home health care, and public health clinics) and telework.
Valuing community and public health nursing	Promoting health equity is a critical responsibility of community and public health nurses. With the onset of the COVID-19 pandemic, the significance of team-based care, infection control and prevention, person-centered care, and other population-based skills has been underscored, highlighting the capabilities of community and public health nurses.
Fostering nurses’ roles as leaders and advocates	The nursing profession requires a new generation of leaders who prioritize diversity and equity and recognize the crucial link between social determinants of health and overall health status. Nurse leaders can also play a critical role in addressing the legacy of racism in health care and the nursing profession and taking steps to reduce the negative impact of discrimination and implicit bias on clients’ health outcomes.
Preparing nurses to respond to disasters	The COVID-19 pandemic has highlighted the divisions in an already fractured U.S. health care system, causing a significant increase in mortality and illness rates and exposing stark health disparities. The communities most severely impacted are people of color, who face the combined challenges of discrimination, financial hardship, dangerous work environments, restricted health care access, and preexisting medical issues. It is crucial to define the responsibilities and duties of nurses in disaster response and public health emergency management to enhance the country’s ability to prepare for and react to such occurrences.
Supporting the health and well-being of nurses	The workplace demands placed on nurses can significantly impact their well-being, compromising the quality and safety of their care. To prevent burnout and poor health among nursing staff, it’s crucial to address the root causes of workplace hazards and stressors. Ultimately, the impact on nurses’ health and well-being goes beyond their personal lives, directly affecting the quality, safety, and cost of care and the overall health care system.

Table 35.7 Areas for Improvement and Corresponding Obstacles to Achieve Health Equity in the Next Decade (See NASEM, 2021.)

Social Responsibility as a Global Citizen

The role of nurses as global citizens goes beyond providing local health care. Nurses must embrace their responsibility to contribute to positive global health outcomes, promote health equity, and address global health challenges. Nurses are prepared to interact with populations from around the world. Being culturally competent and sensitive allows nurses to provide care that respects cultural beliefs, practices, and values. Global citizenship in nursing involves advocating for equal access to quality health care for all individuals regardless of their geographical location, socioeconomic status, or cultural background. Nurses can advocate for policies that address health disparities and promote health equity globally. They also promote global health by educating individuals and communities about disease prevention, hygiene, nutrition, and healthy lifestyles. This knowledge can have a positive impact on public health outcomes worldwide. Additionally, nurses are often at the forefront of responding to disasters and humanitarian crises around the world, providing emergency medical care, supporting displaced populations, and delivering essential health care services.

Global citizenship encourages nurses to collaborate with health care professionals and policymakers across borders, fostering international partnerships that facilitate knowledge-sharing, capacity-building, and skill-sharing projects. Nurses can contribute to global health by participating in educational initiatives and training programs in underserved areas such as third-world communities, helping to strengthen health care systems and empower local health care professionals (Figure 35.6). They can also engage in global public health initiatives, such as promoting sanitation, safe drinking water, and hygiene practices to prevent spreading infectious diseases. Above all, nurses must prioritize the well-being of clients and communities, even in challenging and resource-limited environments.

A speaker stands in the front of the room, holding up a diagram, while seated people look on and listen.

Figure 35.6 This global health initiative by the CDC educates men in Mozambique about voluntary medical male circumcision (VMMC) at a health clinic. (credit: “VMMC in Mozambique” by Ricardo Franco/CDC/Flickr, CC BY 2.0 DEED)

Nurses must continuously learn about and adapt to global health issues, emerging diseases, and evolving health care practices. They should advocate for health equity, promote global health initiatives, collaborate internationally, and provide health care services in diverse settings to improve global health outcomes.

Key to Achieving Positive Health Outcomes

Population health covers public health, acute care, ambulatory care, and long-term care for local, regional, national, and global communities. It involves collaboration between individuals and organizations involved in care, including clients and communities, with a focus on achieving health equity and improved health for all and an emphasis on diversity, equity, inclusion, and ethics. Everyone involved shares accountability for outcomes, as various factors can influence the health of a specific group. Ultimately, a population health perspective is essential in promoting the health and well-being of the community (AACN, 2021a).

Population health encompasses a broad range of health care services, from public health initiatives aimed at preventing diseases to managing the health of entire communities. Population health management involves systems thinking and incorporating health promotion and illness prevention to achieve population health goals.

Nurses advocate for and implement policies that impact population health on a global and local level, and they respond to emergencies, crises, epidemics, or pandemics. This requires a particular focus on surveillance, prevention, and containment of factors contributing to the emergency, with competencies tailored to each situation.

A skilled community/public health nurse carries out many essential functions in community organizations or state and local public health organizations. These functions range from providing clinical services, home visits, and population-based services to conducting health promotion programs at all levels of prevention. The community/public health nurse works directly with at-risk populations, using their population-level competencies to provide services to individuals, families, or groups. Additionally, they perform critical tasks such as primary data collection and analysis, fieldwork, program planning, outreach activities, programmatic support, and other organizational tasks. Although their focus is primarily on population-level competencies and community/public health, nurses apply these skills and competencies across all levels of prevention, making them indispensable members of the health care infrastructure (Quad Council Coalition Competency Review Task Force, 2018).

Community and public health nurses hold the key to achieving positive health outcomes in an era of increasing challenges. By working together and fostering a culture of inclusivity, nurses can create a society where everyone has equal access to health care and can attain their best possible state of wellness.

35.3 Carving a Path Forward

Learning Outcomes

Transforming Nursing Practice

Social Responsibility as a Global Citizen

Key to Achieving Positive Health Outcomes