Chapter 2: Evidence-Based Public Health Nursing Practice

Abby is talking with Jaime, an RN who has returned to school to get his baccalaureate nursing degree. She is struggling to understand the three levels of public health nursing practice. Abby asks, “How do you use the nursing process in your hospital work? Did you ever think you could use it for more than the patients you are caring for?”

Jaime replies, “It still seems kind of strange to me. But I am a member of the Quality Improvement Team. We just finished an audit to look at the incidence of patient falls to find out whether our unit is meeting the goals set by the hospital to reduce the patient fall rate. Our patient fall rate is still higher than the goal set by the hospital, so we decided that we need to hold an in-service on assessing patients for their fall risk and the different protocols we can use to reduce the number of patient falls. So, I guess if we think of my unit as a community, we are using the nursing process at more than one level.”

Abby ponders, “I guess I can kind of see that you are using the nursing process to assess the fall rate. The idea of using the nursing process at the systems level still seems very strange to me.”

Jaime thinks about the idea of nursing at the systems level and finally says, “Maybe if I think of the nursing staff on my unit as part of the hospital system, then Quality Improvement Team members can assess what they know about fall risk and prevention and design a program just for our staff members to improve their skills in that area. What do you think?”

Abby sighs, “I kind of understand how I can use nursing process to assess the health needs of individuals, families, and communities, but I can't think how I would assess the health status of a system. Do systems have a health status?” Abby muses, “If a system, like a public health agency, doesn't have enough money to provide the health services that the community needs, then I guess it wouldn't be very healthy.”

Jaime says thoughtfully, “Maybe we need to look at a community's health needs and determine whether specific community systems, such as hospitals, schools, educational systems, and public health agencies, have the resources to meet the priority needs of their community. If they don't have the resources, then maybe we can plan interventions to help them get the resources or services they need.”