NR717 Week 1 FerdinandAkontai Population Health Concepts

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Welcome to NR717 Concepts in Population Health Outcomes and Health Policy! In this course, you will explore how the DNP-prepared nurse uses population health principles to improve the health of diverse and often-underserved populations. You will start the week by exploring the foundations and evolution of population health. From there, you will examine the determinants of health and how these factors influence the care of populations. You will also investigate culturally and linguistically appropriate healthcare, which we will explore in this week’s lesson, including your organization’s provision of these important services. Additionally, you will create a culturagram and begin analyzing various populations and their healthcare needs. There is so much to learn! It is time to get started on your journey in population health!

Week 1 Student Lesson Plan

Overview

Program Competencies

Course Outcomes
Weekly Objectives
Main Concepts

Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (PO 1)

Schedule

Section	Read/Review/Complete	Course Outcomes	Due
Prepare	Assigned Readings	COs 3, 5	Wednesday
Explore	Lesson	COs 3, 5	Wednesday
Translate to Practice	Discussion: Introduction Post	n/a	Wednesday
Translate to Practice	Discussion: Initial Post	COs 3, 5	Wednesday
Translate to Practice	Discussion: Follow-Up Posts	COs 3, 5	Sunday
Reflect	Reflection	COs 3, 5	No submission

Foundations for Learning

Start your learning for the week by reviewing Healthy People goals:

Healthy People 2030

Since 1979, the U.S. Department of Health and Human Services (HHS) has analyzed data from past decades, integrating new knowledge, current data, trends, and research to determine the nation’s healthcare priorities for the next 10 years. Our nation’s health priorities are associated with many areas such as national health, national preparedness, and disease prevention, as well as identification of risks to health and wellness and changing public health priorities. Planning is underway for the development of Healthy People 2030. For additional information, go to the following website:

Link (website): Healthy People 2030Links to an external site.

Revisit the following textbooks that were required in previous courses:

Dang, D., & Dearholt, S. (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International.

White, K., Dudley-Brown, S., & Terhaar, M. (2021). Translation of evidence into nursing and health care (3rd ed.). Springer Publishing Company.

Student Learning Resources

Click on the following tabs to view the resources for this week.

Required Textbooks

Required Articles
Additional Resources

Bemker, M. A. & Ralyea, C. (2018). Population health and its integration into advanced nursing practice. DEStech Publications, Inc.

Read Chapters 1, 2

Learning Success Strategies

Review the assigned readings to ensure you understand the key terms and can relate them to population health.
As you review weekly content, consider how each concept and discussion can be translated into practice in your unique setting.
Be ready to share your thoughts through the interactive discussion. Review the discussion guidelines and rubric to optimize your performance.
You have access to a variety of resources to support your success. Click on the DNP Resources tab on the home page to access program and project resources.
Your course faculty is here to support your learning journey. Reach out for guidance with study strategies, time management, and course-related questions. Review rubric feedback and individual comments to optimize performance.
Be certain to complete your student attestation, due by Sunday 11:59 p.m. MT. You can locate this by going to Modules and selecting Student Attestation.

Interacting with Feedback

Each week your course faculty will provide feedback in the rubric and on any assignment you have submitted. Take a moment to review the following video on how to view rubric feedback in Canvas:

Link (video): Looking at FeedbackLinks to an external site.(2:26)

Review the following video on how to accept/reject track changes when viewing course faculty feedback on your assignment:

Link (video): Word: Track Changes and Comments(4:19)

Week 1 Lesson 1 Population Health Concepts

The Health of Populations

Population healthcare rises from the premise that individuals will benefit from a focus on improving the health of aggregates (i.e., groups). The DNP-prepared nurse holds the key to improved healthcare outcomes through an understanding of the determinants of health and by intervening to translate evidence into effective strategies and solutions. The DNP-prepared nurse understands the highly specific, often economic and cultural, influences on individuals and populations in diverse communities. In addition, an awareness of the impact of social dynamics on health allows for more effective evidence-based interventions and superior outcomes.

The Centers for Disease Control and Prevention (CDC, 2019) defines population health as “an interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally” (para. 2). The Institute for Healthcare Improvement (2022) adopted a more specific definition of population health coined by Drs. David Kindig and Greg Stoddart who state “The health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group” (para. 2).

Five fundamental principles underpin the care of populations (Ariosto et al, 2018). These guiding principles serve as a basis for the assessment, development, implementation, and evaluation of population-focused interventions.

Click through the following activity to explore the guiding principles underpinning the care of populations.

5 Population-Based Health Principles Interactive Transcript

Community Perspective

Focuses on the aggregate
Prioritizes health concerns
Links population to interventions

Clinical Epidemiology Perspective

Focuses on death, disease, and disability causation
Prioritizes health outcomes
Links individual patients to resources

Evidence-Based Practice Perspective

Focuses on evidence translation
Prioritizes health outcomes
Links evidence to practice

Emphasis on Prevention

Focuses on disease prevention and health promotion
Prioritizes resource allocation and cost attainment
Links risk reduction to improved outcomes

Emphasis on Outcomes

Focuses on outcome measurement
Prioritizes monitoring and evaluation
Links interventions to outcomes data

Populations and Communities

Populations and communities are foundational to population health. A population refers to a group of people who have at least one attribute in common. Populations can be defined by geographical, cultural, or other characteristics that link people together. A community is a collection of populations. Communities may be geographic such as nations, but can also be groups such as employees, ethnic populations, prisoners, the elderly, the military, the chronically ill, or any other defined group. The health outcomes of these groups are of relevance to the DNP-prepared nurse, healthcare providers, policymakers, and others committed to greater possibilities in health.

View the following video to examine the foundations of population health.

Population Health (2:34)

Evolution of Population Health and Epidemiology

Population health in the United States has a relatively short history as the initial focus of healthcare was on the individual rather than on a specific community or population. This shift in emphasis began in the 19th century and is now gaining momentum as the population ages and chronic illnesses have become a central concern of health economics and policy. Epidemiology, with its emphasis on the analysis of the determinants of health and disease conditions in populations, is the cornerstone of population health.

Click through the following timeline to investigate the evolution of population health and epidemiology.

Evolution of Population Health and EpidemiologyLinks to an external site.

Evolution of Population Health and Epidemiology Interactive Transcript

Evolution of Population Health and Epidemiology

Click on each date below to examine milestones in the field of population health.

1945 – The United Nations Conference in San Francisco unanimously approves the establishment of a new, autonomous international health organization: World Health Organization (WHO).
1948 – CDC is established for communicable diseases.
1948 – The International Classification of Disease—the global standard to report and categorize diseases, health-related conditions, and external causes of disease and injury—is published.
1951 – The Epidemic Intelligence Service (EIS) is established, recognizing the need for an adequate corps of trained epidemiologists who can be deployed immediately for any contingency, including chemical or biological warfare.
1953 – The Communicable Disease Center National Surveillance Program is developed to maintain constant vigilance over communicable diseases and to respond immediately when an outbreak occurs.
1961 – CDC takes over publication of Morbidity and Mortality Weekly Report (MMWR) from the National Office of Vital Statistics. MMWR is a weekly publication containing a few short narrative reports and the weekly morbidity and mortality tables. It also publishes the annual Summary of Notifiable Diseases.
1974 – Through the Study of the Efficacy of Nosocomial Infection Control (SENIC), CDC begins to monitor trends in hospital-acquired infection rates.
1988 – Disabilities Prevention Program is developed to provide a national focus for the prevention of disabilities.
1995 – Emerging Infections Program (EIP) is established in response to the Centers for Disease Control and Prevention’s (CDC) 1994 strategy, Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States.
2000 – The Global Outbreak Alert and Response Network is established to detect and combat the international spread of outbreaks.
2001 – The Children’s Health Act (Public Law 106-310) establishes the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at CDC. The Act expands research and services for a variety of childhood health problems and authorizes the establishment of Centers of Excellence at both CDC and NIH to promote research and monitoring efforts related to autism.
2010 – Healthy People 2020 is published by DHHS.
2010 – The Patient Protection and Affordable Care Act is enacted.
2011 – The CDC launches the groundbreaking “Tips from Former Smokers” national ad campaign to increase awareness about the suffering caused by smoking and to encourage smokers to quit.
2014 – The Global Health Security Agenda is initiated.
2016 – CDC responds to the Zika virus outbreak in the Americas and U.S. Territories. CDC confirms that the Zika virus causes birth defects.
- Link (website): Zika Vius: About ZikaLinks to an external site.
2017 – Public health officials announce that drug overdoses have become the leading cause of death for Americans under age 50, with more than two-thirds of those deaths coming from opioid painkillers.
- Link (website): Opiod Overdose: OverviewLinks to an external site.
2019 – The World Health Organization (WHO) names the new disease COVID-19.
- Link (website): COVID-19Links to an external site.
2020 – Africa is declared free of wild poliovirus, the second virus eradicated from the continent since smallpox 40 years previously.

Sources:

Centers for Disease Control and Prevention. (n.d.). CDC Timeline. https://www.cdc.gov/museum/timeline/index.html.

World Health Organization. (2021). History of WHO. http://www.who.int/about/history/en/

Determinants of Health on the Care of Populations

An array of determinants impact health outcomes. Determinants of health are defined as “the range of personal, social, economic, and environmental factors that influence health status” (Office of Disease Prevention and Health Promotion, 2018, para. 3). The environment we live in, the cleanliness of the air, our access to food and water, our social networks, as well as our education and employment opportunities all impact our ability to maintain and sustain health. Another key determinant of health is access to quality, affordable healthcare.

Failure to address the role of socioeconomic, environmental, cultural, and other population-level determinants of health can contribute to the disproportionate burden of disease within specific populations. Consider the Pima Indian population of Arizona and Mexico, who have one of the highest prevalence rates of diabetes in the world (Narayan, 2018). Although the Pima population may be genetically prone to diabetes and obesity, environmental determinants have been major contributors to their burden of disease. Consider, for example, that the average energy expenditure from farming has been reduced with the advent of grocery stores, and that climate change has led to the decline of family gardens and farming as lower rainfall has reduced harvests. Moreover, the low socioeconomic status of this population has resulted in the inability to afford quality, healthy food.

Healthcare providers, including DNP-prepared nurses, must be aware of the determinants of health for populations such as the Pima Indians in order to improve outcomes. Individuals also can contribute to the overall health of a population by enacting laws. For example, In the United States, it is noted that states that enforce distracted driving laws are associated with a lower incidence of fatal accidents involving 16- to 19-year-old drivers. Additionally, the adoption of texting bans on all handheld devices is associated with the most significant decrease in fatal accidents (Flaherty, 2020).

Determinants of Health Image Description

Determinants of Health

The range of factors from the individual, social, socioeconomic, cultural, and environment levels, as well as access to healthcare that impacts the health of individuals, populations, and communities.

Individual Determinants

Age
Gender
Diet
Physical activity
Substance use
Family health history

Social Determinants

Social norms and attitudes
Exposure to media and emerging technologies
Socioeconomic conditions
Quality schools
Transportation options
Public safety
Residential segregation

General Socioeconomic, Cultural, and Environment Conditions

Agriculture and food production
Education
Work environment
Unemployment
Water and sanitation
Healthcare services
Housing, homes, and neighborhoods
Exposure to toxic substances

Health Services

Lack of available healthcare
High cost of healthcare
Lack of insurance coverage
Limited language access
Inability to receive preventive services

Policy

Policies at the local, state, and federal levels that affect the health of the individual, population, or community

Week 2 Lesson 2 Culturally Appropriate Healthcare

Culturally and Linguistically Appropriate Healthcare

The population of the United States is rapidly diversifying, making culturally and linguistically appropriate healthcare a top priority. The DNP-prepared nurse must be culturally competent and provide high-quality care to diverse populations. Culturally competent care is associated with improved healthcare outcomes, including increased satisfaction with care, increased perceptions of quality healthcare, and better communication and adherence to treatments (Henderson et al., 2018). However, to be effective, culturally competent care requires the DNP-prepared nurse to be aware of personal assumptions and biases, both implicit and explicit.

National Standards for Culturally and Linguistically Appropriate Services

The Health and Human Services Office of Minority Health established the National Standards for Culturally and Linguistically Appropriate Services (CLAS) to guide healthcare institutions in providing culturally competent healthcare. These standards provide a blueprint for advancing health quality and equity.

Link (website): National Standards for Culturally and Linguistically Appropriate Services (CLAS)Links to an external site.

Consider your organization’s standards. Review the following interactive and consider the noted questions.

National Standards Interactive Transcript

Do they support a culturally varied workforce and patient population?

How do the values of the organization’s leaders help shape the workplace culture?

What strategies will you use as a DNP-prepared nurse to create a culturally competent organization?

Now, apply culturally and linguistically appropriate services to the case study below.

An Example of Culturally and Linguistically Appropriate ServicesLinks to an external site.

Case Study Interactive Transcript

An Example of Culturally and Linguistically Appropriate Services

A middle-aged Chinese male was admitted for cataract surgery. Following the procedure, he refused pain medication. The nurse assessed that he was restless and appeared uncomfortable, and again offered pain medication. The patient still refused, stating that he could bear the pain and that her responsibilities were many and he didn’t want to impose. The nurse then reassured him that his comfort was one of her top responsibilities.

What role, if any, does culture play in this scenario?

Click here to find out.

Chinese people are taught self-restraint. The needs of the group are often considered more important than those of the individual.

Another factor that may be involved in the patient’s refusal of pain medication is courtesy. Asians generally consider it impolite to accept something the first time it is offered.

What is the best course of action? Click here to learn more.

The safest approach for the nurse is to anticipate the needs of an Asian patient for pain medication without waiting for requests. Nurses must be aware of Asian rules of etiquette when offering pain medication, food, or other services. If the patient continues to refuse medication, his wish should be respected.

Continue.

Now, let’s consider culturally appropriate services at the population level. Population-based surveys have identified cataracts as the leading cause of blindness and visual impairment in China, which has the largest number of people in the world with these afflictions (Zhang et al., 2017).

Given that Chinese people are more at risk to develop cataracts and less likely to receive treatment than other populations, what is one evidence-based intervention you might consider to address the population as a whole?

Click here to explore a possible intervention.

Zhang et al. (2017) report that, although cataract surgery is an effective means to reverse cataract blindness, the cataract surgical rate in China is low due to a lack of experienced surgeons in rural areas and costs of surgery in urban centers. These barriers have resulted in a large number of patients who have little or no access to affordable surgical services. To overcome this disparity, Project Vision was established to create a sustainable model to reduce cataract blindness in rural China. The top priority of this nongovernmental organization is to develop rural charity eye centers for training local doctors to provide high-quality and low-cost cataract surgery (Zhang et al., 2017).

Reference

Zhang, X., Li, E. Y., Leung, C. K. S., Musch, D. C., Tang, X., Zheng, C., … & Lam, D. S. C. (2017). Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China. PloS one, 12(8), e0180769. https://doi.org/10.1371/journal.pone.0180769

Culturally Appropriate Care

In nursing, the individual wants and needs of those receiving care must be considered. Population health is no different. Just as cultural practices and beliefs may impact the types of care consumed by an individual, communities or populations may also have cultural practices that impact the types of services required. For example, if the community does not eat processed foods, a service such as Women, Infants, and Children (WIC) that offers these food items may not be sought out. Similarly, an immunization program offered to children through local health departments and providers may not be utilized if a population or community does not believe in the need to vaccinate.

Population Culturagrams

A strong foundation in techniques that foster better care delivery pave the way for the DNP-prepared nurse to champion culturally competent care. A culturagram enables one to assess the impact of culture on health, become more empathic with regard to cultural differences, and empower culturally diverse populations to achieve better health (Jayshree & Okundaye, 2014).

View the essential components of the culturagram below. Refer to this diagram when creating a culturagram to address a selected population in this week’s discussion.

Population Image Desccription

Population

Contact with cultural and religious institutions’ holidays, food, and clothing
Oppression, discrimination bias, and racism
Values about education, work, family structure, and power
Language spoken at home and in community
Time in community
Health beliefs
Effects of trauma and crisis events

PreviousNext

Week 1

References

Ariosto, D., Harper, E., Wilson, M., Hull, S., Nahm, F., & Sylvia, M. (2018). Population health: A nursing action plan. JAMIA Open, 1(1) 7-10. https://doi.org/10.1093/jamiaopen/ooy003

Centers for Disease Control and Prevention. (2019). What is population health. https://www.cdc.gov/pophealthtraining/whatis.html

Centers for Disease Control and Prevention. (2020). CDC timeline. https://www.cdc.gov/museum/timeline/index.html

Epstein, L. H., & Wen, X. (2018). Relevance of social networks for adolescent obesity. JAMA Pediatrics, 172(3), 223-224. https://doi.org/10.1001/jamapediatrics.2017.4983

Flaherty, M. R., Kim, A. M., Salt, M. D., & Lee, L. K. (2020). Distracted driving laws and motor vehicle crash fatalities. Pediatrics, 145(6). https://doi.org/10.1542/peds.2019-3621

Healthcare Information and Management Systems Society. (2019). Population health. https://www.himss.org/population-health

Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community, 26(4), 590-603.

Institute for Healthcare Improvement. (2022). Population health.
http://www.ihi.org/Topics/Population-Health/Pages/default.aspx

Jayshree J., & Okundaye, J. (2014). The Culturagram: An educational tool to enhance practice competence with diverse populations. Journal of Baccalaureate Social Work, 19(1), 53-63.

Narayan, K. V., Kondal, D., Kobes, S., Deepa, M., Daya, N. R., Patel, S. A., Anjana, R. M., Staimez, L. R., Ali, M. K., Gujral, U., Prabhakaran, D., Shivashankar, R., Kadir, M., Selvin, E., Mohan, V., Hanson, R. L., & Tandon, N. (2019). 1597-P: Incidence of diabetes in young adult south Asians compared with Pima Indians. Diabetes, 68 (Supplement 1). https://doi.org/10.2337/db19-1597-P

Office of Disease Prevention and Health Promotions. (2019). Determinants of health. https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

World Health Organization. (2019). WHO at 70. https://www.who.int/news-room/detail/05-04-2018-who-at-70—working-for-better-health-for-everyone-everywhere

Zhang, X., Li, E. Y., Leung, C. K. S., Musch, D. C., Tang, X., Zheng, C., He, M., Chang, D. F., & Lam, D. S. C. (2017). Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China. PloS One, 12(8), e0180769. https://doi.org/10.1371/journal.pone.0180769

Week 1 Leading Culturally and Linguistically Appropriate Healthcare Discussion

Purpose

This week you discovered that the focus of healthcare has a growing emphasis on population health. This includes an emphasis on quality improvement and tracking outcomes. The purpose of this discussion is to apply the key concepts in population health to a selected population.

Instructions

Select a population you would like to engage throughout the course to explore important population health and health policy concepts. Potential populations to consider are listed below. You may want to refer to the Global Burden of Disease or one of the eight National Practice Problems to identify the population you will be examining in this course. You may examine the same health issue you have been researching in the previous courses, or you may select another topic of interest to complete the assignments unique to this course.

Address the following as they relate to the population you have selected:

Create a culturagram for your selected population. Refer to the lesson for guidance in creating a culturagram. You may use the attached template if you desire.
- Link: (Word doc): Culturagram TemplateLinks to an external site.
Identify three key social determinant risk factors associated with the population.
Conduct a search of the literature. Identify one evidence-based intervention to reduce health disparities in your selected population.
Examine how the selected intervention addresses at least one of the standards from the Culturally and Linguistically Appropriate Standards (CLAS).

Potential Populations

Asian population in Torrance, California
Somali-Americans in Minneapolis, Minnesota
African American population in Jackson, Mississippi
Hopi Indians in Kykotsmovi Village, Arizona
Caucasian population in Martin County, Kentucky
Hispanic/Latino population in Hialeah, Florida

Note: You may consider a different population as long as there is an abundance of literature related to social determinant risk factors and statistical data (prevalence, incidence, and economic ramifications) available for the selected health issue so that you can complete the required assignments each week.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

Link (webpage): DNP Discussion GuidelinesLinks to an external site.

Program Competencies

This discussion enables the student to meet the following program competencies:

Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (PO 1)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

Assimilate epidemiology principles and interventions to impact the social determinants of health, Global Burden of Disease, and population health outcomes. (PCs 7, 8; PO 1)
Formulate strategies for providing culturally relevant and high-quality healthcare to vulnerable and high-risk populations to address social injustice and health inequities. (PCs 7, 8; PO 1)

Due Dates

Initial Post: By 11:59 p.m. MT on Wednesday
Follow-Up Posts: By 11:59 p.m. MT on Sunday

Sample Week 1 Discussion

Hello Dr. Kinsey and Class,

Identify three key social determinant risk factors associated with the population.

Social determinants of health play a significant part in an individual’s health outcomes (Kim et al., 2020). Blacks in Mississippi comprise 37 percent of the population and are responsible for the highest mortality rates of heart disease, hypertension, stroke, diabetes, and cancer (Mississippi State Department of Health, n.d.) In this discussion, I have reviewed three key social determinant risk factors associated with the black population in Jackson, Mississippi. The top three are poor economic stability, lack of education, and limited access to healthcare resources. These factors are complex and have overlapping with significant implications to this population’s health.

Economic stability is the most influential of the three, influencing many other social determinants. Economic factors, including employment, income, community safety, and social support, affect how well this population can live and thrive. The economic climate determines a person’s ability to make healthy choices, afford housing and medical care, and become educated (Kim et al., 2020).

Education is an essential factor in a person’s overall health risks. Research shows a significant increase in poverty rates among people 25 years and older who have not completed a high school education (Smegma et al., 2018). Education influences employment opportunities, income level, and ability to afford health insurance (Gottlieb et al., 2019).

Health care is essential to the health of all Americans. Mississippi is one of the 12 states that has not expanded Medicaid under the Affordable Care Act. If Medicaid were expanded, the federal government would cover 90% of healthcare costs, and the state would cover the additional 10% (Mississippi Today, 2022). This would allow for increased healthcare access in Jackson and the rest of the state.

Conduct a search of the literature. Identify one evidence-based intervention to reduce health disparities in your selected population.

Cervical cancer rates among women in Mississippi are among the highest in the country. The Centers for Disease Control reported that women in Mississippi develop cervical cancer at a rate of 9.3 for every 100,000, compared to 6.8 per 100,000 for those women in California (2019). Not only are cervical cancer rates higher in Mississippi, but mortality rates from this preventable disease are also high compared to other states. In Mississippi alone, cervical cancer deaths are 3.9 per 100,000, the fourth highest in the country (CDC, 2019).

As discussed above, the risk factors related to the social determinants of health in Jackson, Mississippi, play a significant role in these staggering statistics. Lack of education can influence a person’s ability to gain employment and therefore have inadequate access to health insurance. Furthermore, a lack of economic stability can lead to insufficient healthcare resources within a community and a lack of transportation to healthcare clinics to receive care.

In my literature search, I have identified an evidence-based intervention to decrease the rates of cervical cancer-related deaths by increasing cervical cancer screening and surveillance. The proposed intervention is to mail human papillomavirus (HPV) test kits to women’s homes in Jackson, to improve the uptake of cervical cancer screening based on a study by Winer et al. (2019). This will eliminate the need to women to travel to receive GYN services, pay costly co-payments for an in-person appointment, and reduce the need to take time off work to attend an office visit to receive their cervical cancer screening.

Examine how the selected intervention addresses at least one of the standards from the Culturally and Linguistically Appropriate Standards (CLAS).

My selected intervention meets the Culturally and Linguistically Appropriate Standards (CLAS) by addressing the principal standard of, “providing effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs (HHS, n.d)” This low-risk intervention meets the needs of the black, female community in Jackson while working within the current infrastructure. It improves women’s healthcare access while being sensitive to the effects of previous trauma and discrimination this population has experienced in the healthcare community. The mailed kits can also be a means to provide additional education and knowledge around cervical cancer prevention and screening in the comfort of the home so the woman can feel empowered to learn more.

References

Bleich, S., Findling, M., Casey, L., (2019). Discrimination in the United States: Experiences of black Americans. Health Services Research. 54: 1399– 1408. https://doi.org/10.1111/1475-6773.13220Links to an external site.

Center for Disease Control and Prevention. (2019). Cancer Statistics at a Glance. https://gis.cdc.gov/Cancer/USCS/#/AtAGlance/Links to an external site.

Gottlieb, L., Fichtenberg, C., Alderwick, H., & Adler, N. (2019). Social determinants of health: What’s a healthcare system to do? Journal of Healthcare Management, 64(4), 243–257. https://doi.org/10.1097/JHM-D-18-00160Links to an external site.

Kim, E., Abrahams, S., Uwemedimo, O., & Conigliaro, J. (2020). Prevalence of social determinants of health and associations of social needs among United States adults, 2011–2014. Journal of General Internal Medicine : JGIM, 35(5), 1608–1609. https://doi.org/10.1007/s11606-019-05362-3Links to an external site.

Mississippi State Department of Health. (n.d.). Health Equity. https://msdh.ms.gov/page/44,0,236.htmlLinks to an external site.

Royals, K. (2022, March 9). It makes it hard to work: the real cost of not expanding medicaid in Mississippi. Mississippi Today, https://mississippitoday.org/2022/03/09/mississippi-medicaid-expansion-cost-work/Links to an external site.

Semega J., Kollar M., Creamer J., Mohant A. (2018). Income and poverty in the United States. https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-266.pdLinks to an external site.

U.S. Department of Health and Human Services. (n.d.). National culturally and linguistically appropriate services standards. https://thinkculturalhealth.hhs.gov/clas/standardsLinks to an external site.

Winer, R., Lin, J., Tiro, J. A., Miglioretti, D. L., Beatty, T., Gao, H., Kimbel, K., Thayer, C., & Buist, D. S. M. (2019). Effect of mailed human papillomavirus test kits vs usual care reminders on cervical cancer screening uptake, precancer detection, and treatment: A randomized clinical trial. JAMA Network Open, 2(11), e1914729–e1914729. https://doi.org/10.1001/jamanetworkopen.2019.14729Links to an external site.

Week 2: Epidemiology and Health Surveillance

Week 2 Student Lesson Plan

Overview

Program Competencies

Course Outcomes
Weekly Objectives
Main Concepts

Analyzes health care policies to advocate for equitable health care and social justice to all populations and those at risk due to social determinants of health. (POs 2, 9)
Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (PO 1)

Schedule

Section	Read/Review/Complete	Course Outcomes	Due
Prepare	Assigned Readings	COs 2, 3	Wednesday
Explore	Lesson	COs 2, 3	Wednesday
Translate to Practice	Discussion: Initial Post	COs 2, 3	Wednesday
Translate to Practice	Discussion: Follow-Up Posts	COs 2, 3	Sunday
Reflect	Reflection	COs 2, 3	No submission

Foundations for Learning

Start your learning this week by reviewing commonly used epidemiologic measures, such as morbidity and mortality rates:

Centers for Disease Control and Prevention. (2012). Principles in epidemiology in public health practice: An introduction to applied epidemiology and biostatisticsLinks to an external site. (3rd ed.). https://www.cdc.gov/csels/dsepd/ss1978/index.html

U.S. Burden of Disease Collaborators. (2018). The state of U.S. health, 1990-2016: Burden of diseases, injuries, and risk factors among U.S. states.Links to an external site. JAMA, 319(14), 1444-1472. https://doi.org/10.1001/jama.2018.0158

Student Learning Resources

Click on the following tabs to view the resources for this week.

Required Textbooks

Required Articles
Required Web Resources
Additional Resources

Bemker, M. A., & Ralyea, C. (2018). Population health and its integration into advanced nursing practice. DEStech Publications, Inc.

Read Chapter 14

Learning Success Strategies

Review the assigned readings to ensure you understand the key terms and can relate them to population health.
As you review weekly content, consider how each concept and discussion can be translated into practice at your unique setting.
Be ready to share your thoughts through the interactive discussion. Review the discussion guidelines and rubric to optimize your performance.
You have access to a variety of resources to support your success. Click on the DNP Resources tab on the home page to access program and project resources.
Your course faculty is here to support your learning journey. Reach out for guidance with study strategies, time management, and course-related questions. Review rubric feedback and individual comments to optimize performance.

Interacting with Feedback

Each week your course faculty will provide feedback in the rubric and on any assignment you have submitted. Take a moment to review the following video on how to view rubric feedback in Canvas:

Link (video): Looking at FeedbackLinks to an external site.(2:26)

Review the following video on how to accept/reject track changes when viewing course faculty feedback on your assignment:

Link (video): Word: Track Changes and Comments(4:19)

Week 2 Lesson 1 Foundations in Epidemiology

Epidemiologic Concepts

Epidemiology is the study of the variables that determine and influence the frequency and distribution of health, disease, injury, and other health-related events and their causes (Gordis, 2014). Zeni (2019) notes that the value of epidemiology is far beyond the distribution and determinants of health-related events. A key purpose of epidemiology is the application of findings in health promotion, healthcare, and health policy to enhance the health and well-being of populations. Only with this fundamental knowledge can the DNP-prepared nurse implement effective strategies to mitigate or eliminate the risk factors associated with disease. Epidemiological concepts and terminology have a long history; Florence Nightingale used these concepts in the Crimean War to measure the rates of death and illness per 1,000 soldiers (Gammon & Hunt, 2018). Her use of epidemiological concepts brought to the forefront the devastating effect that communicable diseases have on morbidity and mortality rates. Although epidemiologic thinking has been traced throughout history, it blossomed as a discipline following World War II. Today, epidemiology is used regularly to characterize the health of communities and to solve day-to-day problems, both simple and complex.

Epidemiologic Triangle

Since the era of Florence Nightingale, several models of disease causation have emerged. The simplest of these models is the epidemiologic triangle, which consists of an external agent, a susceptible host, and an environment that brings the host and agent together to impact health and produce disease.

View the following diagram to examine how agent, host, and environmental factors interrelate to produce disease.

Epidemiologic Triangle Image Description

The Epidemiologic Triangle

Agent – Virulence, Infectivity of a Pathogen, Addictive Qualities of a Substance of Abuse

Environment – Sanitary Conditions, Social Context, Availability of Healthcare

Host – Genetic Susceptibility, Resiliency, Nutritional Status, Behavior

Web of Causation

Another model addressing disease causation is the web of causation. Unlike the epidemiologic triangle, this model addresses multiple factors that interact to produce disease. These many determinants make up the web of causation and underpin the population health model of multiple causation.

Now, view the following diagram to investigate how multiple factors interact to produce disease

Web of Causation Image Description

Despite concerns that culture is immutable, once precise mechanisms linking cultural variants and health outcomes are identified and modified, culture change and health improvements can occur. Strategies to improve health outcomes must simultaneously target co-occurring risks through integrative approaches, rather than use more fragmented approaches that address single risk factors.

Morbidity and Mortality Rates

Epidemiologic measurements are statistical calculations used to determine outcome data in population health. Diseases are often studied using the epidemiologic principles of morbidity and mortality rates. Morbidity is the condition of being ill, diseased, or unhealthy, and includes both acute and chronic illnesses. Mortality rates refer to the number of deaths in a population over time, either in general or due to a specific cause.

View the following video to consider how morbidity and mortality rates are used to analyze health changes over time.

Measuring Morbidity and Mortality Rates of a Population (1:28)

Transcript

Let’s begin our investigation into epidemiologic calculations by examining morbidity and mortality rates in population health. And he refers to the incidence of ill-health within a population. Morbidity rates help determine the risks of an illness in a population. Mortality refers to the number of deaths in a population and is usually calculated as the number of deaths per thousand individuals per year. If we look at diabetes and heart disease, diseases related to the eight national practice problems, both conditions have low morbidity rates. However, heart disease has a greater mortality rate than diabetes. Unlike heart disease and diabetes, obesity and Alzheimer’s Disease have higher morbidity rates. However, Alzheimer’s disease has a greater mortality than obesity. Changes in morbidity and mortality rates over time and within specific populations provide important data regarding population health. This graph illustrating CDC statistics, shows the age adjusted mortality rates for many diseases over time. Look how mortality rates related to Alzheimer’s disease have increased in the United States in the recent years. Conversely, mortality rates related to cerebrovascular disease have decreased during the same period.

Life Expectancy Rates

Another frequently used epidemiologic calculation is life expectancy rates. Life expectancy is a measure of the average time of life of an individual, based on the year of birth, current age, and other demographic factors.

View the following video to examine life expectancy rates and the measure of premature mortality.

Life Expectancy: Premature Mortality Rates (1:35) Transcript

[MUSIC] Hello, I’m back to guide your investigation into life expectancy rates and the measure of premature mortality. Life expectancy at birth is one of the most common ways to calculate life expectancy. It can also be calculated as the remaining life expectancy for any given age. However, if the average life expectancy at birth for one individual is 79 years, the remaining average life expectancy of that same individual at 72 years old is 7 years. In population health, the years of potential life lost is often calculated in reference to mortality. This is useful in measuring the outcomes of population health interventions. Let’s consider the years of potential life lost, YPLL, for diabetes. Consider an intervention aimed at stabilizing A1C levels in a population of ten patients. The patients in this study range in age from 22 to 67. If diabetes has the potential to reduce life expectancy by nine years, the total life expectancy for the group of ten patients is 233 years. The long-term goal of the intervention is to increase the life expectancy of diabetic patients through the maintenance of stable A1C levels for five years for individuals under the age of 50. And three years for those over the age of 50. If this occurs, the years of potential life lost decreases by 42 years. The outcome associated with this long-term intervention decreases the years of potential life lost due to diabetes by 42 years for the 10 patients. [MUSIC]

Incidences and Prevalence Rates

Other commonly used epidemiologic statistical measures are incidence and prevalence rates. Incidence is a measure to determine an individual’s probability of being diagnosed with a disease during a given period of time. Prevalence is a measure to determine an individual’s likelihood of having a disease.

View the following video to explore the incidences and prevalence rates of disease.

Incidences and Prevalence Rates (2:36)

Descriptive and Analytic Epidemiology

Epidemiologic research utilizes two methodologies to gather data regarding the distribution and determinants of events and diseases in groups of people: descriptive epidemiology and analytic epidemiology. Descriptive epidemiology examines the patterns of disease occurrence, with a focus on person, place, and time. Different from this approach that uses relatively accessible data, analytic epidemiology aims to quantify the association between exposures and outcomes and test hypotheses about causal relationships. Both methodologies are useful in generating evidence to promote health.

View the following video to explore how descriptive and analytic epidemiology are used to promote population health outcomes.

Descriptive and Analytic Epidemiology (4:50) Transcript

[MUSIC] Like other scientists, the five Ws, what, who, where, when, and why/how provide epidemiologists with a method to collect comprehensive information regarding health event. Unlike other scientists, epidemiologists use synonyms for the five Ws. The what refers to the health issue of concern. The who would be the person. Where is the place. The when is the time. And the why/how are the causes, risk factors, and modes of transmission. Descriptive epidemiology is concerned with organizing and analyzing data in order to understand variations in disease frequency, geographically and over time, and how disease or health varies among people based on personal characteristics. It focuses primarily on the three Ws, person, place, and time. Let’s take a closer look at these three Ws of descriptive epidemiology. Personal determinants influence health.

Measuring characteristics such as age, sex, race, marital status, and other personal data are helpful to identify health trends. Personal characteristics are helpful when evaluating population health interventions and their impact on disease. Place also influences health, measuring whether a disease affects a specific geographic region is important to determine causation. It is also important to determine if population health intervention influences the disease cases in a given area. For example, a disease maybe specific to a small area such as a park or a building, but maybe as large as a country or continent. Diseases and other population health issues change over time.

Measuring and displaying the patterns of disease occurrence by time are critical for monitoring disease within a community. Cases are monitored chronologically to determine whether population health interventions improve outcomes by decreasing occurrences. Next, let’s consider analytic epidemiology. Analytic epidemiology is concerned with the search for causes and effects, or the why and the how. Epidemiologists use analytic epidemiology to quantify the association between exposures and outcomes, and to test hypothesis about casual relationships.

Now let’s take a look at how these approaches differ. The difference between descriptive and analytic epidemiology is the use of a controlled group to develop hypothesis about casual relationships. Descriptive epidemiology will provide the time, place, and person involved in the health issue. But it is through an analytic approach that appropriate control and prevention measures can be developed to improve health outcomes. Consider the Salmonella outbreak in 2018 where 92 people were infected. The CDC was able to trace the determinant back to raw chicken by looking at those infected and those not infected. Let’s take a look at some important findings using descriptive epidemiology.

Illnesses were evaluated from January 19th, 2018 to September 9th, 2018. Ill people ranged in age from less than 1 year to 105, with a median age of 36. 69% of ill people were female. Of 62 people with information available, 21 of them or 34% were hospitalized. No deaths were reported. You can view the location of people infected with the outbreak strain of Salmonella Infantis by state of residence as of October 15th, 2018. [MUSIC] Now let’s consider an example of when epidemiologists use descriptive epidemiology to test a hypothesis. Consider the large outbreak of hepatitis A that occurred in Pennsylvania in 2003. Investigators found that most of the patients had eaten at a particular restaurant two to six weeks before the onset of illness.

The investigators needed to confirm which particular food may have been contaminated. The investigators asked the patients which restaurant foods they had eaten, and enrolled and interviewed a comparison or a control group. A group of persons who had eaten at the restaurant during the same period but who did not get sick. Of 133 items on the restaurants menu, the striking difference between the case and control groups was in the proportion of people who ate salsa. 94% of the case patients ate the salsa, compared with only 39% of the controls. Further investigation of the ingredients in the salsa implicated green onions as the source of infection. The Food and Drug Administration issued an advisory to the public about green onions and the risk of hepatitis A due to convincing results of the analytic epidemiology. [MUSIC]

Week 2 Lesson 2 Health Surveillance

Gathering Health Information through Surveillance

Population health issues often merge with public health service, especially in the monitoring of infections and infectious disease (Jarvis et al., 2020). Data analysis is playing a pivotal role in merging these practices by aligning surveillance with disease investigation and control. Health departments are collecting and analyzing data at greater rates than ever before, making surveillance integral to protecting the health of individuals and populations. Surveillance involves the ongoing collection, analysis, and interpretation of health-related data. Although the objectives for surveillance vary for each disease monitored, the ultimate goal of surveillance is to disseminate data to those responsible for population health prevention and control. This data is essential for the planning, implementation, and evaluation of public health practices including disease prevention, prevention program planning and management, health promotion, quality improvement, and resource allocation.

View the following video to explore the role of surveillance in population health.

Surveillance (8:48) Transcript

Let’s explore surveillance and its role and use in population health. First, we ask, what is the problem? In population health, we identify the problem by using surveillance systems. After we’ve identified the problem, the next question is, what is the cause of the problem? For example, are there factors that might make certain populations more susceptible to disease? After we’ve identified the risk factors related to the problem, we ask, what intervention works to address the problem? We look at what has worked in the past in addressing the same problem and if a proposed intervention makes sense with our affected population.

In the last step, we ask, how can we implement the intervention? Given the resources we have and what we know about the affected population, will this work? When you hear the term public health surveillance, what do you think of? Simply put, the term surveillance comes from a French word meaning to watch over. The more clinical definition is ongoing, systematic collection, analysis, and interpretation of health-related data essential to planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control. Let’s look at the goal of public health surveillance.

The goal of public health surveillance is to provide information that can be used for health action by public health personnel, government leaders, and the public to guide public health policy and programs. Let’s do a quick knowledge check. The correct answer is B, to provide information to be used for public health action. Now that we’ve defined public health surveillance, let’s discuss its role and uses in public health. Here are some specific ways public health surveillance can be used. Identify patients and their contexts for treatment and intervention.

Detect epidemics, health problems, changes in health behaviors. Estimate magnitude and scope of health problems. Measure trends and characterize disease. Monitor changes in infectious and environmental agents. Assess effectiveness of programs and control measures. Develop hypotheses and stimulate research. Now let’s look at its legal basis. You might have asked yourself, how can public health officials conduct surveillance without a person’s permission? Or how do public health authorities decide if they have the right to conduct surveillance in a particular circumstance.

Legal authority for states to conduct public health surveillance is based on the U.S. Constitution into specific clauses: general welfare and interstate commerce. The federal government is charged with promoting the general welfare of the people, and it has authority over interstate commerce. CDC can respond when a disease has interesting implications because of the commerce clause. Otherwise, CDC typically must be invited by a state to conduct surveillance or investigations within its borders. State-based notifiable disease surveillance systems, also called reportable disease systems, are mandated by law or regulation and specify not only who must report but also the list of diseases to report, how to report. and when.

In certain states, laws and regulations also allow the state health officer to mandate reporting of specific diseases or conditions. Most commonly providers, laboratories, hospitals, clinics, and other health professionals are required to report cases to the local health department. The local health department is usually responsible for the case investigation and any resulting actions. After the local health department receives and verifies a report, they then send the report to the state health department. Now, let’s investigate population health surveillance types and attributes. Let’s look at the two primary types of population health surveillance, passive and active.

In passive surveillance, the physician, laboratory, or healthcare provider takes the initiative in submitting the report by following the list of reportable diseases in that state. It is the most common type of surveillance. It is simple and inexpensive, but it is also limited by variability of quality and completeness in reporting. Active systems involve regular outreach to potential reporters to stimulate the reporting of specific diseases or injuries. Active surveillance can validate the representativeness of passive reports, ensure more complete reporting of conditions, or be used in conjunction with specific epidemiologic investigations.

There are two other types of surveillance you may hear about: sentinel and syndromic. They are both defined here. Sentinel surveillance, reporting of health events by health professionals who are selected to represent a geographic area or a specific reporting group, can be active or passive. Syndromic surveillance focuses on one or more symptoms rather than a physician-diagnosed or laboratory-confirmed disease. It’s time for another knowledge check. The correct answer is B, active. Next, let’s review the process involved in surveillance. There are five key steps in the surveillance process: data collection, analysis, interpretation, dissemination, and follow-up.

Let’s begin by looking at data collection. Possible questions to ask might include, what will we monitor? Who will collect the data, and how will it be collected? Where do we implement the system? How will the data be transmitted to the person performing the analysis? Surveillance relies on a variety of data sources to monitor different conditions and situations. You might be familiar with some of the data sources listed here: reported diseases or syndromes; electronic health records, such as hospital discharge data; vital records, such as birth and death certificates; registries, such as cancer and immunizations; and surveys, such as National Health and Nutrition Examination Survey, NHANES.

The Nationally Notifiable Disease Surveillance System is supported by the CDC Division of Health Informatics and Surveillance, DHIS. Much of the information collected in the NNDSS is published by the CDC weekly in the Morbidity and Mortality Weekly Report, or MMWR, and the final data annually in the MMWR Annual Summary of Notifiable Diseases. Now let’s look at data analysis. During this step, we must determine who will analyze the data, what methodology will they use, and how often will the data be analyzed? Surveillance data analysis usually includes descriptive information consisting of time, place, and person. However, other analytic methods are often used.

The next step is data interpretation. By identifying person, place, and time, you can more easily determine how and why the health event happened. Data dissemination describes how to distribute information to those who need to know: health agency newsletters, bulletins or alerts, surveillance summaries and reports, medical and epidemiological journal articles, press releases, and social media. Link to action is the final and required step in the public health surveillance process because, without action, the collected data serve no real purpose. Public health surveillance-based action includes the following five steps. Describe the burden of or potential for disease. Monitor trends and patterns in disease, risk factors, and agents. Detect sudden changes in disease occurrence and distribution. Provide data for programs, policies, and priorities, and evaluate prevention and control efforts.

Improving Outcomes through Surveillance

Just as in any other healthcare setting, the goal of the DNP-prepared nurse in population health is to improve outcomes. Surveillance is used in population health to gather data to guide evaluation of population health programs and interventions. Surveillance data reveals if an intervention is needed and whether it is successful in addressing the population health problem. For example, if an outbreak of salmonella is being monitored and new food preparation practices are being implemented, surveillance is needed to ensure the decline of salmonella cases. If the number of salmonella cases continue to rise, the intervention may not be the right solution.

Using Surveillance to Determine Causation

The DNP-prepared nurse must also give careful thought to the principle of causation when planning the implementation of a population health intervention. Consider an intervention to improve the quality of life of Appalachian coal miners. One potential intervention is a smoking cessation program for miners newly approved for disability benefits due to chronic obstructive pulmonary disease (COPD). Following implementation of the intervention, results may indicate an improvement in the quality of life of these individuals; however, it may be difficult to prove causality. Are the improved outcomes related to the smoking cessation intervention? Or are the improved outcomes a result of the miners no longer being exposed to the coal mine? Cause does not always correlate to effect. This intervention requires further surveillance to determine causation.

Ethical Issues Related to Surveillance

Health surveillance is not without ethical issues. Klingler et al., (2017) identified numerous ethical issues associated with using surveillance to promote health. For example, the privacy or autonomy rights of the individual is an ethical conundrum when surveillance yields more complete and reliable data to support the health of many. The reliability of surveillance systems and data are also ethical considerations, as is the potential of inflicting emotional or social harm through the labeling of individuals or communities as suffering from health issues.

View the following activity to reflect upon ethical considerations related to surveillance.

Ethical Issues Related to Surveillance Interactive Transcript

Selecting a framework for conducting public health surveillance
Deciding which public health surveillance system should be realized
Designing the public health surveillance system
Protecting autonomy/the right to privacy
Protecting the right to privacy/confidentiality in data reporting and sharing
Avoiding inflicting harm or restricting freedom when labeling individuals/communities as suffering from health issues
Using data for public health

Week 2 References

Gordis, L. (2014). Epidemiology (5th ed.). Elsevier Saunders.

Jarvis, T., Scott, F., El-Jardali, F., & Alvarez, E. (2020). Defining and classifying public health systems: A critical interpretive synthesis. Health Research Policy and Systems, 18(1), 1-12. https://doi.org/ 10.1186/s12961-020-00583-z

Khan, S. (n.d.). Correlation and causality [Video]. Khan Academy. https://www.khanacademy.org/math/probability/scatterplots-a1/creating-interpreting-scatterplots/v/correlation-and-causality

Klingler, C., Silva, D. S., Schuermann, C., Reis, A. A., Saxena, A., & Strech, D. (2017). Ethical issues in public health surveillance: A systematic qualitative review. BMC Public Health, 17(295), 1-13. https://doi.org/10.1186/s12889-017-4200-4

Zeni, M. (2019). Principles of epidemiology for advanced nursing practice: A population Health perspective. Jones & Bartlett Learning.

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Week 2 Epidemiology and Health Surveillance Discussion

Purpose

The purpose of this discussion is to apply concepts in epidemiology and health surveillance to a selected population.

Instructions

Explore the determinants of health and the National Practice Problems that most affect the population you selected in Week 1. Review the following index to locate an epidemiological report published by the Centers for Disease Control and Prevention (CDC).

Link (website): CDC A-Z IndexLinks to an external site.

This report contains data on specific diseases as reported by state and regional health departments, as well as recommendations that have been issued by the CDC.

Use the index to review the most significant issue pertaining to your selected population and one of the eight National Practice Problems to address the following:

Explore the epidemiologic principles and measures used to address your selected practice problem at the national and specific geographic (city or county level) location for the population you have selected.
Examine the use of descriptive and/or analytic epidemiology to address the practice problem.
Propose how you might use surveillance to influence the determinants of health and improve the health outcomes of your population.
Anticipate any ethical concerns that you might have related to the use of surveillance data in your population.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

Link (webpage): DNP Discussion GuidelinesLinks to an external site.

Program Competencies

This discussion enables the student to meet the following program competencies:

Analyzes health care policies to advocate for equitable health care and social justice to all populations and those at risk due to social determinants of health. (POs 2, 9)
Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (PO 1)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

Synthesize ethical and legal principles to advocate for value-based, equitable, and ethical health policies at the micro, meso, and macrosystem levels. (PC 5; PO 9)
Assimilate epidemiology principles and interventions to impact the social determinants of health, Global Burden of Disease, and population health outcomes. (PCs 7, 8; PO 1)

Due Dates

Initial Post: By 11:59 p.m. MT on Wednesday
Follow-Up Posts: By 11:59 p.m. MT on Sunday

Sample Week 2 Discussion Post

INITIAL RESPONSE POST

My focus is on heart disease in the African American population in Hinds County, Jackson, Mississippi. The estimated national average mortality rate for adults with heart disease in African Americans (both men and women) for the time period of 2018-2020 is 416.9 per 100,000 (Centers for Disease Control and Prevention, 2020a). Unfortunately, Hinds County, (Jackson) Mississippi reports are higher than the national average. In Jackson, the estimated average mortality rate for adults with heart disease for African Americans (both men and women) for 2018-2020 is 433.3 per 100,000 (Centers for Disease Control and Prevention, 2020a). The population of African Americans in Hinds County is 72.6%, and the median household income is $45,000, with 25.9% of the county living in poverty (Centers for Disease Control and Prevention, 2020a). Further, 46% of the population has high blood pressure, however, 29.8% of African Americans self-report non-adherence to all blood pressure medication types (Centers for Disease Control and Prevention, 2020a). Additionally, 6.9% have coronary heart disease, 38.7% are obese, and 31% report physical inactivity (Centers for Disease Control and Prevention, 2020a). Life expectancy for the State of Mississippi is 74.9, and the life expectancy for the many census tracts in Hinds County, Jackson, Mississippi is either slightly below or above the state figure (Centers for Disease Control and Prevention, 2020b). This is lower than the national average for life expectancy which was estimated at 79.9 years in 2020.

Descriptive epidemiology is useful to examine people or populations considering their demographic and socioeconomic factors with the end goal of understanding and reducing health risks and diseases. In the retrospective study performed by Barber et al. (2016) on data taken from the Jackson Heart Study, they discovered that African Americans residing in disadvantaged neighborhoods with no social togetherness, violence, and disorder experienced higher incidences of heart disease. Further, it is hypothesized that this socioeconomic factor limits access to healthy foods, opportunities for safe physical activities, and leads to chronic stress levels (Barber et al., 2016). The constant high stress experienced by African Americans in disadvantaged neighborhoods may directly contribute to hypertension and chronic inflammation, leading researchers to believe there may be a direct causal link between poverty, crime-ridden neighborhoods, and heart disease (Barber et al., 2016). Additionally, Min et al. (2017) found that a diagnosis of depression in African Americans has been positively linked to higher rates of cardiovascular disease. Perceived discrimination, negative psychosocial factors, and perceived disparities have an impact on the health of African Americans when compared to other ethnic minorities (Min et al., 2017).

I could use surveillance data to influence the determinants of health and improve the health outcomes of the African American population in Jackson, Mississippi. I would start with the data that is available from the Jackson Heart Study, which began in 1998 and has been gathering data since that time (Barber et al., 2016). In the three-year surveillance study done by Mendy et al. (2020), they discovered that the highest population in Mississippi that was diagnosed with hypertension were African Americans, aged 30-64, mostly male, and classified as obese. Uncontrolled hypertension is the greatest risk factor for heart disease, and the leading cause of death in Mississippi (Mendy et al., 2020). The surveillance data gathered by Mendy et al. (2020) came from random telephone surveys and self-reported census data. There were no ethical considerations because participants were voluntary, and no money was offered (Mendy et al., 2020). Mendy et al. (2020) proposed community-based outreach programs along with aggressive workplace intervention programs to target this population and help to lower their risk of developing hypertension.

Additionally, Qobadi and Payton (2017) reported on telephone surveillance data collected from the Mississippi Behavioral Risk Factor Surveillance System on adults who consumed sugar-sweetened beverages. According to Qobadi and Payton (2017), Mississippi has the highest obesity rate out of all fifty states in America. Again, there were no ethical considerations because the participants were voluntary and could choose not to participate (Qobadi & Payton, 2017). The surveillance data revealed that sugar-sweetened beverages were consumed daily predominantly by younger adult black males, living at or below the poverty level, were smokers, ate daily at fast-food chains, and self-reported no physical activity (Qobadi & Payton, 2017). Research shows that fast-food options are cheaper and more easily accessible than healthier food options (Qobadi & Payton, 2017). Further, marketing campaigns that target younger generations, employment opportunities, and lack of knowledge of fat and calorie content all contributed to the findings (Qobadi & Payton, 2017). Targeted interventions, introducing alternatives to sugar-sweetened beverages, and community outreach education on the fat and calorie content of fast food are proposed resolutions for African American consumers in Mississippi (Qobadi & Payton, 2017).

The Centers for Disease Control and Prevention has a campaign that is aimed at African Americans called the “Live To the Beat” campaign (Centers for Disease Control and Prevention, 2023c). The aim is to reduce the incidences of heart disease in African Americans aged 35-54 (Centers for Disease Control and Prevention, 2023c). The campaign contains a toolkit that contains personal stories, printable pamphlets, educational videos, and downloadable graphics that can be used by healthcare professionals or community outreach workers (Centers for Disease Control and Prevention, 2023c).

References

Barber, S., Hickson, D.A., Wang, X., Sims, M., Nelson, C., & Diez-Roux, A.V. (2016). Neighborhood disadvantage, poor social conditions, and cardiovascular disease incidence among African American adults in the Jackson Heart Study. American Journal of Public Health, 106(12), 2219-2226. doi:10.2105/AJPH.2016.303471

Centers for Disease Control and Prevention. (2020a). Interactive atlas of heart disease and stroke. Retrieved March 11, 2023, from https://nccd.cdc.gov/DHDSPAtlas/?state=County

Centers for Disease Control and Prevention. (2020b). Life expectancy at birth for U.S. states and census tracts, 2010-2015. Retrieved March 11, 2023, from https://www.cdc.gov/nchs/data-visualization/life-expectancy/index.html

Centers for Disease Control and Prevention. (2023c). “Live to the Beat” Campaign Toolkit. Retrieved March 12, 2023, from https://millionhearts.hhs.gov/partners-progress/partners/live-beat-campaign-toolkit.html

Mendy, V.L., Vargas, R., Ogungbe, O., & Zhang, L. (2020). Hypertension among Mississippi workers by sociodemographic characteristics and occupation, behavioral risk factor surveillance system. International Journal of Hypertension, 2020, 1-6. doi: 10.1155/2020/2401747

Min, Y.I., Anugu, P., Butler, K.R., Hartley, T.A., Mwasongwe, S., Norwood, A.F., Sims, M., Wang, W., Winters, K.P., & Correa, A. (2017). Cardiovascular disease burden and socioeconomic correlates: Findings from the Jackson Heart Study. Journal of The American Heart Association, 6(8), 1-21. doi: 10.1161/JAHA.116.004416

Qobadi, M., & Payton, M. (2017). Consumption of sugar-sweetened beverages in Mississippi: Is there a disparity? Behavioral risk factor surveillance system, 2012. International Journal of Environmental Research and Public Health, 14(3), 228-238. doi:10.3390/ijerph14030228

Week 3: Prevention, Interventions, and Population Health Programs

Week 3 Student Lesson Plan

Overview

Program Competencies

Course Outcomes
Weekly Objectives
Main Concepts

Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (PO 1)

Schedule

Section	Read/Review/Complete	Course Outcomes	Due
Prepare	Assigned Readings	COs 3, 5	Wednesday
Explore	Lesson	COs 3, 5	Wednesday
Translate to Practice	Discussion: Initial Post	COs 3, 5	Wednesday
Translate to Practice	Discussion: Follow-Up Posts	COs 3, 5	Sunday
Reflect	Reflection	COs 3, 5	No submission

Foundations for Learning

Start your learning for the week by reviewing Healthy People goals:

Healthy People 2030

Link (website): Healthy People 2030 Links to an external site.

Student Learning Resources

Click on the following tabs to view the resources for this week.

Required Textbooks

Required Articles
Additional Resources

Bemker, M. A., & Ralyea, C. (2018). Population health and its integration into advanced nursing practice. DEStech Publications, Inc.

Read Chapter 14

Learning Success Strategies

Review the assigned readings to ensure you understand how to apply levels of prevention to promote health and wellness.
As you review weekly content, consider how each concept and discussion can be translated into practice at your unique setting.
Be ready to share your thoughts through the interactive discussion. Review the discussion guidelines and rubric to optimize your performance.
You have access to a variety of resources to support your success. Click on the DNP Resources tab on the home page to access program and project resources.
Your course faculty is here to support your learning journey. Reach out for guidance with study strategies, time management, and course-related questions. Review rubric feedback and individual comments to optimize performance.

Interacting with Feedback

Each week your course faculty will provide feedback in the rubric and on any assignment you have submitted. Take a moment to review the following video on how to view rubric feedback in Canvas:

Link (video): Looking at FeedbackLinks to an external site.(2:26)

Review the following video on how to accept/reject track changes when viewing course faculty feedback on your assignment:

Link (video): Word: Track Changes and Comments(4:19)

Week 3 Lesson 1 Prevention and Interventions in Population Health

Wellness Promotion and Illness Prevention

The DNP-prepared nurse utilizes evidence-based models and practices to improve health outcomes. In population health, the shift in national priorities from illness management to wellness and illness prevention has placed emphasis on prevention-focused interventions for outcome improvement. Prevention methods are often categorized as primary, secondary, and tertiary levels of prevention, according to the objective of the intervention (CDC, n.d.); all levels of prevention management aim to improve outcomes across populations.

Synthesize ethical and legal principles to advocate for value-based, equitable, and ethical health policies at the micro, meso, and macrosystem levels.

View the following image to examine the levels of prevention.

PST Image Description

Primary = Prevention

Secondary = Screening

Tertiary = Treatment

Primary Prevention

Primary prevention targets disease or disability prevention. These interventions focus on health promotion and address a universal population. Primary prevention interventions occur across settings, including healthcare organizations, school-based health clinics, faith-based organizations, and community venues. One example of a primary prevention intervention is a program to promote breastfeeding to reduce the occurrence of childhood obesity and comorbidities. Another example of primary prevention is vaccination programs to reduce the occurrence of infectious diseases.

View the following video to explore primary prevention in action.

Levels of Prevention (0:43)

Reflect

Now reflect upon these primary prevention interventions.

Expert Answer Interactive Transcript

Card 1

The opioid epidemic in the United States is a deadly crisis that transcends age, ethnicity, health status, and economic status (Cox & Nagle, 2019). Providing education can help to reduce the stigma of those with opioid use disorders. What primary prevention intervention would help reduce the stigma related to opioid use disorders?

Expert Answer: Through primary prevention, healthcare providers can prevent initial opioid exposure by educating patients of the associated risks, using risk stratification, and minimizing opioid dose and duration.

Card 2

Many healthcare workers refuse to be immunized for influenza (Kwok et al., 2020). What primary prevention intervention is needed to increase the number of healthcare professionals receiving the influenza vaccination?

Expert Answer: It is important to understand why healthcare providers decline the influenza vaccine. Education is a primary prevention strategy that can help increase healthcare provider vaccination rates. For example, if a healthcare provider has an egg allergy, educate them on other types of vaccines that are available, like the egg free recombinant vaccine. If a healthcare provider has a fear of needles, educate them on jet injectors. Identifying barriers is key to increasing healthcare provider influenza vaccine rates. The use of educational decision aids can help increase the rate of influenza vaccination in healthcare providers (Saunier et al., 2020).

Secondary Prevention

Secondary prevention focuses on identifying already occurring health problems or conditions prior to the onset of serious or long-term problems. These interventions address selected or targeted symptomatic populations. The objective of secondary prevention is early diagnosis and initial treatment or stabilization of disease in the early stages before it causes significant morbidity and mortality. These interventions can occur in all the same venues as primary interventions, as well as in emergency departments and retail-based clinics (Moreland & Curran, 2018).

View the following video to discover secondary prevention in action.

Secondary Prevention (0:33)

Reflect

Now reflect upon these secondary prevention interventions.

The health of a child is often dependent on the parents’ ability to provide access to healthcare. Taking time away from work, transportation issues, and other barriers may prevent parents from obtaining an early diagnosis of their child’s illness. One secondary prevention intervention is school-based clinics. These clinics, which are located primarily within high schools, can be staffed by advanced practice nurses, dentists, mental health professionals, and health educators. The availability of clinics allows for students to return to school earlier while improving health outcomes (Bemker & Ralyea, 2018).

Expert Answer Interactive Transcript

What other secondary prevention intervention would benefit this population?

Expert Answer: Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. A secondary intervention that could benefit school age children is a program presented to the faculty to help identify signs or symptoms of bullying.

Mental health care for the population of individuals who are serving or have served in the military is a rising priority (Stein et al., 2019). One area of need is the use of secondary prevention methods to assess the potential for self-harm or suicide.

Expert Answer Interactive Transcript

What secondary prevention may help to reduce the suicide rate in the military population?

Expert Answer: The suicide rate is approximately 21% higher in the Veteran population than their civilian peers. Substantial decreases in suicide rates have been achieved by screening with the Columbia Suicide Severity Rating Scale, an evidence-based tool that is effective not only as a predictor of suicide risk but also is preventative when appropriately used at every point of care.

Tertiary Prevention

Tertiary prevention aims to slow or stop the progression of disease. These interventions target individuals who are already diagnosed with a disease condition and work to restore function and reduce disease-related complications (Moreland & Curran, 2018).

View the following video to investigate tertiary prevention in action.

Tertiary Prevention (0:44)

Reflect

Now reflect upon these tertiary prevention interventions.

Expert Answer Interactive Transcript

Preterm birth is a leading contributor of perinatal morbidity and mortality (Patil et al., 2021). What tertiary prevention intervention is needed to help reduce the occurrence of preterm birth?

Expert Answer: A large number of women who are at risk for preterm birth also experience chronic diseases like diabetes or hypertension. Management of these chronic diseases can decrease preterm births.

Population Health Interventions

Population health interventions typically address one of the three levels of prevention and target the population as a whole. For example, an intervention may encompass individuals who are at risk for breast cancer, influenza, or impacted by a tornado. These interventions are not free. Funding plays a significant role in the creation and management of population health interventions, while health policy informs the type of interventions as well as the resource allocation.

The Minnesota Model Intervention Wheel

The Minnesota Department of Health developed a framework to underpin the most common interventions in population health. This framework, called the “intervention model” or “wheel,” defines the type of population-based intervention, as well as the level of practice, including systems, community, the individual, and/or family. Essentially, the intervention framework provides a systematic approach to practice. Despite its age, this population health intervention planning tool is still widely utilized by health practitioners today.

View the following interactive to examine how each intervention component aligns across the levels of practice and click on the plus signs for further explanation of each component.

The Minnesota Model Intervention Wheel Interactive Transcript

Surveillance: Collection, analysis, and interpretation of health data
Disease and health event investigation: Gathering and analyzing data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures
Outreach: Locating vulnerable populations and providing information about the nature of the concern
Screening: Identifying individuals with unrecognized health risk factors or asymptomatic disease conditions in populations
Referral and follow- up: Making connections to necessary resources to prevent or resolve problems or concerns
Case management: Collaborating on a process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet client needs
Delegated functions: Directing care tasks a registered professional nurse carries out under the authority of a healthcare practitioner as allowed by law
Health teaching: Sharing information and experiences through educational activities
Counseling: Establishing an interpersonal relationship with professional services to enhance self-care and coping
Consultation: Seeking information and solutions to problems or issues through interactive problem solving
Collaboration: Committing two or more persons or organizations to achieve a common goal
Coalition building: Promoting alliances among organizations for a common purpose
Community organizing: Identifying common problems or goals, mobilizing resources, and developing strategies for reaching objectives
Advocacy: Promoting and protecting the health of individuals and communities by collaborating with stakeholders
Social marketing: Applying marketing principles and techniques via a systematic planning process
Policy development and enforcement: Placing health issues on decision-makers’ agendas

(Minnesota Department of Health, 2019)

Population Health Programs

Population health programs are created as interventions to address a population health concern. Health policy also drives health programs. Consider the Women, Infants, and Children (WIC) program. This program was created to provide supplemental nutrition for childbearing women, breastfeeding mothers, and infants and children up to age five. WIC has specific qualification guidelines to ensure those at greatest risk receive nutritional support.

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Week 3 Lesson 2 Stakeholder Identification and Interprofessional Collaboration

The Role of the Stakeholder in Addressing National and Local Practice Problems

Click on the following tabs to learn more about the role of the stakeholder in addressing national and local practice problems

National Level

The role of stakeholders when identifying practice problems is too crucial to overlook. Influencing practice outcomes requires partnerships that bring practice scholars together with clinicians, civic groups, social service providers, and educational leaders, among many others. This is proving to be an effective means of influencing the health of the nation. Among their benefits, stakeholder partnerships help communities prioritize clinical problems and health needs, as well as streamline resources to address them.

Translating the best available evidence can improve health outcomes, but factors beyond clinicians’ control often limit their influence, such as patients’ education, employment, and social support. To address the social and economic factors that affect health, practice change initiatives must reach beyond the traditional boundaries of the healthcare system. One promising approach is the use of community-based partnerships that bring a wide range of stakeholders—healthcare providers, educators, business leaders, social service providers, community organizations, and clergy—together to promote healthy behavior, improve access to primary and preventive care, and reduce health disparities.

Local Level

Interprofessional Collaboration and Practice

Why Interprofessional Collaboration (IPC)?

Why be concerned about creating a supportive environment for translation of the best available evidence to influence a practice problem? The most obvious answer is that interprofessional team members are continually under pressure to address practice problems by closing the gap between known research evidence and the reality of everyday practice. To do this complex work, collaboration and mutual respect across roles and work responsibilities are requirements.

IPC is the process in which different professional groups work together and value the expertise and contributions that each brings to the team to positively impact healthcare processes and delivery (White et al., 2016). The World Health Organization (WHO, 2010) defined interprofessional collaborative practice as multiple health workers from different professional backgrounds working together with patients, families, caregivers, and communities to deliver the highest quality of care.

View the following video to investigate strategies to facilitate interprofessional collaboration.

Interprofessional Collaboration (4:58) Transcript

Leading interprofessional collaboration requires establishing a shared vision of collaboration among health professionals, that facilitates a culture of evidence translation, and practice improvement. How is this actually accomplished? Let’s take a closer look to discover interprofessional collaboration in action. Interprofessional team members are continually under pressure to address practice problems by closing the gap between known research evidence and the reality of everyday practice. To do this complex work, collaboration and mutual respect across roles and work responsibilities are crucial.

Interprofessional collaboration, or IPC, is the process in which different professional groups work together and value the expertise and contributions that each brings to the team, to positively impact healthcare processes and delivery. The World Health Organization defines interprofessional collaborative practice as multiple health workers from different professional backgrounds working together with patients, families, caregivers and communities to deliver the highest quality of care. Evidence-based practice, quality improvement, patient-centered care and informatics are just a few of the competencies required for the successful work of intra-professional teams.

The WHO Framework for Action on Interprofessional Education and Collaborative Practice propose this series of action steps to develop and facilitate full commitment to interprofessional collaborative practice. These action steps are, step one, agree on a common vision and purpose for interprofessional education with key stakeholders across all facilities and organizations. Step two, develop interprofessional education curriculum according According to principles of good educational practice. Step three, provide organizational support and adequate financial and time allocation for the development and delivery of interprofessional education and staff training in interprofessional education. Step four, introduce interprofessional education into health worker training programs.

Step five, ensure that staff responsible for developing, delivering and evaluating interprofessional education are competent in the task, have expertise consistent with the nature of the planned interprofessional education, and to have the support of an interprofessional champion. Step six, ensure the commitment to interprofessional education by leaders in education institutions and all associated practice and work settings. As with any healthcare process, IPC can be viewed from a system approach. A systems approach to IPC includes, role clarification Patient, client, family, community-centered care, team functioning, collaborative leadership, interprofessional communication, and dealing with interprofessional conflicts.

Interprofessional team building and teamwork are critical for implementing practice changes and knowledge translation. IPC teambuilding is a dynamic process. To be successful the team must include and appreciate the diversity team members. Team members must be aware of their mental models and their influence on diversity, role delineation, and responsibilities. Let’s take a look at two important aspects of interprofessional collaboration. The first being communication. Why is skilled communication among health professionals so difficult to achieve? This can be attributed to years of silo education and practice along with a Hierarchy Work Culture that was the norm for many years.

An Interprofessional Communication Plan is detailed with communication goals, type of information shared within the team, and the mode and vehicle for communication. The second important concept within interprofessional collaboration is leadership. How is an IPC team implemented at all levels of the organization? A clear, valued and shared vision of collaboration is articulated, identifying collaboration as essential for evidence, translation and practice improvement. Fundamental to success is visible leadership that supports evidence based practice initiatives by setting priorities, identifying and optimizing resources, diagnosing barriers and facilitators and walking the talk.

Examples of walking the talk would include executive leaders who ask what evidence and best practices exist to solve an identified problem and who then support the management team to problem solve, evaluate evidence and make recommendations for change. These efforts must involve not only the immediate management team, but also collaboration with multiple internal and external stakeholders, the interprofessional team. While this brief overview of interprofessional collaboration highlights a few of the key concepts, it is not all encompassing. The DNP prepared nurse must know all components of IPC to participate in and lead interprofessional collaboration to improve healthcare outcomes.

Interprofessional Collaboration Components

The WHO Framework for Action on Interprofessional Education and Collaborative Practice proposed a series of action steps (WHO, 2010) not meant to be prescriptive, but used to develop and facilitate the transition to full commitment to interprofessional collaborative practice.

Local Health Context Image Description

Fundamental to success is visible leadership that supports evidence-based practice initiatives by setting priorities, identifying and optimizing resources, diagnosing barriers and facilitators, and walking the talk. Examples of walking the talk would include executive leaders who ask what evidence and best practices exist to solve an identified problem and who then support the management team to problem-solve, evaluate evidence, and make recommendations for change. These efforts must involve not only the immediate management team but also the collaboration with multiple internal and external stakeholders—the interprofessional team.

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References

Bemker, M. A., & Ralyea, C. (2018). Population health and its integration into advanced nursing practice. DEStech Publications, Inc.

Centers for Disease Control and Prevention. (n.d.). Picture of America: Prevention. Retrieved May 20, 2021 from https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf

Cox, K., & Naegle, M. (2019). The opioid crisis. Nursing Outlook, 67(1), 3-5. https://doi.org/10.1016/j.outlook.2018.12.016

Faucett, J. (2020). Veteran suicide risk reduction: A recommendation for practice. The Journal for Nurse Practitioners, 16(10), A1-A28. https://doi.org/10.1016/j.nurpra.2020.09.016

Kwok, K. O., Li, K. K., Wei, W. I., Tang, A., Wong, S. Y. S., & Lee, S. S. (2020). Influenza vaccine uptake, COVID-19 vaccination intention and vaccine hesitancy among nurses: A survey. International Journal of Nursing Studies, 114, 103854. https://doi.org/10.1016/j.ijnurstu.2020.103854

Minnesota Department of Health. (2019). Public health interventions: Applications for public health nursing practice (2nd ed.). https://www.health.state.mn.us/communities/practice/research/phncouncil/docs/PHInterventions.pdf

Moreland, S., & Curran, J. (2018). A guide for monitoring and evaluating population-health-environment programs (2nd ed.). https://www.measureevaluation.org/resources/publications/ms-18-131

Patil, A., Grotegut, C., Gaikwad, N., Dowden, S., & Haas, D. (2021). Prediction of neonatal morbidity and very preterm delivery using maternal steroid biomarkers in early gestation. PloS One, 16(1), 1-15.

Saunier, F., Berthelot, P., Mottet- Auselo , B., Pelissier, C., Fontana, L., Botelho-Nevers, E., & Gagneux-Brunon , A. (2020). Impact of a decision-aid tool on influenza vaccine coverage among HCW in two French hospitals: A cluster-randomized trial. Vaccine, 38(36), 5759-5763.

Stein, M. B., Kessler, R. C., & Ursano, R. J. (2019). Reframing the suicide prevention message for military personnel. JAMA Psychiatry, 76(5), 466-68. https://doi.org/10.1001/jamapsychiatry.2018.3943

World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice

NR717 Week 3 Population Health Interventions Discussion

Purpose

The purpose of this discussion is to demonstrate your understanding of interventions to address population health problems and reduce health disparities.

Instructions

Using your selected population, continue your search and appraisal of evidence by analyzing one research study that offers a potential intervention to address your selected population health issue. This intervention must be at the population level. This research study must be new, one that was not used in a previous course.

Appraise a quantitative research study that utilizes an intervention to address the selected health issue identified in Week 2 using the Johns Hopkins Research Appraisal Tool.

Link (Word doc): Johns Hopkins Research Appraisal ToolLinks to an external site.

Transfer your findings to the Johns Hopkins Individual Evidence Summary Tool.

Link (Word doc): Johns Hopkins Individual Evidence Summary ToolLinks to an external site.

Analyze the evidence summary tool of the research study to address the following in the discussion:

Determine whether the intervention has the potential to impact the issue. Explain your rationale.
Attach the completed Johns Hopkins Individual Evidence Summary Tool.
Present the translation science model that would best aid the success of this intervention and discuss how the stakeholders are integrated into the design of the theory or model.
Identify where your selected intervention is located on the Minnesota Public Health Wheel.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

Link (webpage): DNP Discussion GuidelinesLinks to an external site.

Program Competencies

This discussion enables the student to meet the following program competencies:

Translates a synthesis of research and population data to support preventative care and improve the nation’s health. (PO 1)
Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (PO 1)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

Assimilate epidemiology principles and interventions to impact the social determinants of health, Global Burden of Disease, and population health outcomes. (PCs 7, 8; PO 1)
Formulate strategies for providing culturally relevant and high-quality healthcare to vulnerable and high-risk populations to address social injustice and health inequities. (PCs 7, 8; PO 1)

Due Dates

Initial Post: By 11:59 p.m. MT on Wednesday
Follow-Up Posts: By 11:59 p.m. MT on Sunday

Week 3 Discussion Sample

Intervention Impact

Over the past couple of weeks I’ve focused on obesity and increasing physical activity within the African American population in Jackson, MS. Compared to Caucasians, African Americans experience much higher incidences of metabolic disorders and cardiovascular disorders. I’ve covered several risk factors in my previous posts, however through my research, I found an article, Nam et al. (2021) that provided insight on a risk factor that I hadn’t considered before. This study examined how perceived racial discrimination in African Americans contributes to poor health, obesity, decreased physical activity, and health disparities. While a number of factors influence health disparities, African Americans report perceived racial discrimination more than any other ethnic or racial groups. The pilot study used an intensive, observational, case-crossover design of African Americans (n=12) recruited from the community (Nam et al., 2021).

The inclusion conditions were that all participants self-reported as African American/black, English speaking, employed, were between the ages of thirty and fifty-five, owned a smartphone, and was able to reply at a minimum of three times daily to random survey prompts (Nam et al., 2021). Those who were pregnant, or afflicted with serious acute or terminal medical illnesses were excluded from the study as this would interfere with physical activity (Nam et al., 2021).

Forty percent of the participants were obese. The twelve participants were asked to complete baseline surveys and over the course of the next seven days they were instructed to wear accelerometers. Accelerometers are devices that capture and measure the participants’ physical activity levels. The participants also received Ecological Momentary Assessments five times per day over the course of the next seven days. The goal was to capture and assess racial discrimination in real time each day. In the analysis of within-person level data, the accelerometer did indeed observe that the participants were more sedentary on the days when they experienced more perceived discrimination than usual.

As with many studies, this one came with limitations. The small sample size offered limited evidence to support whether or not racial discrimination is a precursor to decreased physical activity or other sedentary behaviors when compared with other studies of general psychological stress (Nam et al., 2021). In the future, studies should consider more extensive racial discrimination approaches, a larger participant sample, and Ecological Momentary Assessments in an effort to decide its ideal frequency to accurately capture discriminatory encounters and survey its relationship with health behaviors (Nam et al., 2021). Safety, walkability, and crime in neighborhood environments are all associated with a person’s physical activity levels despite the overall findings being mixed. Location is everything and where African Americans live is absolutely crucial for their quality of life. The fact that many neighborhoods are still very much segregated with African Americans often residing in poorly funded communities perplexes me. Social stresses such as discrimination may provoke unhealthy behaviors and is linked to the consumption of smoking, alcohol, and fatty food consumption.

As obesity within African Americans can occur for a variety of reasons, it’s important to properly assess patients in order to get to the root of their problems. Questions we may wonder as healthcare professionals are: What does your diet consist of? What do you typically consume in a day? What medications are you taking? Have you ever had issues with your thyroid? Are you employed? What is your family history? Are you able to purchase healthy food options? How many days per week are you able to exercise for thirty minutes or more? Once the causative factors are identified it will make it easier to implement an intervention. If their obesity is linked to an organic cause, treat the disease. If finances are an issue, refer them to those who will be able to assist. My intervention absolutely has the potential to impact my practice problem. The intervention that I will be addressing is making the neighborhood safer, which will in turn increase the likelihood that people in the community will become more physically active. At the population level a strategy to design changes within the community may need to be implemented. In overweight children school based physical education can be enhanced.

Free suggestions to patients would be to become more active by avoiding elevators and taking stairs instead. Parking their cars further from their destination will encourage them to walk further. Participate in sports or other physically challenging activities such as skating or even walking through malls can be safe alternatives to walking outside. New walking trails can be created to increase availability or a heavier police presence can be made at existing ones. Creating walking groups can be beneficial as there is usually more safety in numbers. Offering more free gym memberships to those in need within the community can also be beneficial. I’m pretty sure that the Young Men’s Christian Association/Young Women’s Christian Association (YMCA/YWCA) already offers free memberships to low income individuals and families. Providing equitable and inclusive access is foundational to my practice problem (Centers for Disease Control and Prevention, 2019).

Translation Science Model

Translation science is defined as an area of research that constantly advances translation models that work in the unpredictable reality of daily practice. It is essential to be able to influence practice problems by having the capability to translate research evidence into day to day clinical practice. The probability of effective evidence implementation into practice increases when using the systematic approach of a conceptual model/framework. The translation science models are diffusion of Innovation, Knowledge-to-Action (KTA), Normalization Process Theory (NPT), and I-PARIHS model. It was difficult for me to choose between the I-PARIHS model and Knowledge-to-Action, however I ultimately felt that Knowledge-to-Action would best aid in the success of my intervention’s implementation into practice. Knowledge-To Action is appropriate for the sustainability approach. Knowledge-to-Action concentrates on bridging gaps between what is known versus what is implemented into practice (Kim et al., 2021). The Knowledge-to-Action Framework is comprised of two parts which are The Knowledge Cycle and the Action Cycle (Field et al., 2014). The Knowledge Cycle and the Action Cycle encompass multiple phases. Each component involves several segments which are sometimes repetitive or overlap one another. The Action Cycle exhibits activities necessary for data to be implemented in practice (Graham et al., 2006).

The action phase of the Knowledge-To Action model encompasses recognizing and assessing the problem and established research, identifying obstacles and achievements, planning, implementing, monitoring, analyzing, and making adjustments (Burd et al., 2020). The final stage of the Knowledge-To Action model is knowledge use sustainment. In regard to the knowledge phase, what is known is that obesity is a major problem in African Americans in Jackson, MS. The action is devising a plan to help reduce obesity in my selected population. This will bridge the gap of what is known (obesity) versus what is implemented into practice. I would integrate the stakeholder into the design of the model by first deciding who the appropriate local level stakeholder would be to propose my intervention to. Networking with stakeholders, both informal and formal leaders, is crucial as a practicing scholar. This also establishes a collaborative relationship that is necessary to concentrate on a practice problem with the goal of translating the best obtainable evidence. Stakeholders also possess a deep level of understanding and knowledge as it relates to practice priorities and available resources. Interprofessional Collaboration (IPC) is the practice in which several professional groups work in unison and value the knowledge set and contributions that one another brings to the team (White et al., 2021). This in turn positively impacts healthcare processes and delivery (White et al., 2021). Keeping a constant line of communication with local level stakeholders is just as important as it is with national level stakeholders.

Minnesota Public Health Wheel

This again was difficult to choose from as several of the stages of the Minnesota Public Health Wheel were applicable to my intervention. The two that I feel are most relevant are advocacy and policy development/enforcement. By collaborating with stakeholders I am protecting and promoting the health of my chosen population as well as the overall community. I also feel that at this stage I am ready to put my concerns and interventions on the decision makers’ radar.

References

Burd, C., Gruss, S., Albright, A., Zina, A., Schumacher, P., & Alley, D. (2020). Translating Knowledge into Action to Prevent Type 2 Diabetes: Medicare Expansion of the National Diabetes Prevention Program Lifestyle Intervention. The Milbank Quarterly, 98(1), 172–196. https://doi.org/10.1111/1468-0009.12443Links to an external site.

Centers for Disease Control and Prevention. (2019) Strategies to Increase Physical Activity. Retrieved on March 19, 2023. https://www.cdc.gov/physicalactivity/activepeoplehealthynation/strategies-to-increase-physical-activity/index.htmlLinks to an external site.

Field, B., Booth, A., Ilott, I., & Gerrish, K. (2014). Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implementation Science, 9(172). https://doi.org/10.1186/s13012-014-0172-2Links to an external site.

Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? The Journal of Continuing Education in Health Profession, 26(1). DOI: 10.1002/chp

Kim, E., Lee, M., Kim, E.-H., Kim, H. J., Koo, M., Cheong, I. Y., & Choi, H. (2021). Using knowledge translation to establish a model of hospital-based early supported community reintegration for stroke patients in South Korea. BMC Health Services Research, 21(1), 1359–1359. https://doi.org/10.1186/s12913-021-07400-5Links to an external site.

Minnesota Department of Health. (2019). Public health interventions: Applications for public health nursing practice (2nd ed.). https://www.health.state.mn.us/communities/practice/research/phncouncil/docs/PHInterventions.pdfLinks to an external site.

Nam, Jeon, S., Ash, G., Whittemore, R., & Vlahov, D. (2021). Racial Discrimination, Sedentary Time, and Physical Activity in African Americans: Quantitative Study Combining Ecological Momentary Assessment and Accelerometers. JMIR Formative Research, 5(6), e25687–e25687. https://doi.org/10.2196/25687Links to an external site.

White, K., Dudley-Brown, S., & Terhaar, M. (2021). Translation of evidence into nursing and health care (3rd ed.). Springer Publishing Company.

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