Embracing the population health framework in nursing research

Preliminary instrument development to measure implementing a population health approach in sexual health

OBJECTIVES

This study aims to describe the preliminary development and validation of an instrument to measure the extent that a population health approach was applied in sexual health by public health units in Ontario, Canada.

DESIGN

Preliminary scale development and administration occurred in two phases that included item development and validity testing.

MEASUREMENT AND SAMPLE

Two phases of development included: (1) using literature and expert input (n = 6) to develop items; and (2) validation of items by content experts (n = 5) and pre-testing (n = 3).

RESULTS

The validated scale consisted of 69 items across the eight key elements of a population health approach. 15 out of 35 health units completed the survey, representing 43% of health units. Instrument administration revealed that Focus on the Health of Populations and Address the Determinants of Health and their Interactions were implemented more frequently compared to Collaborate Across Sectors and Levels and Employ Mechanisms for Public Involvement, which were infrequently implemented.

CONCLUSION

This preliminary scale is a way for sexual health programs to measure the extent that a population health approach is implemented by their organization. Further testing with a broader sample is needed to strengthen generalizability and address reliability.

"I had hope. I loved this city once.": A mixed methods study of hope within the context of poverty

The purpose of this emergent mixed methods study was to measure hope in individuals living in poverty and to explore potential contextual influences on hope. We used a sequential mixed methods study in which the quantitative phase was administered first followed by a qualitative phase. Participants in impoverished areas scored higher in hope than a comparison group of university students. In a follow-up qualitative phase, participants named contributors to and detractors from hope that included experiences driven by environmental factors. Findings were organized according to Ecological Systems Theory (EST). Participants named factors from all levels of EST, and interactions between levels were evident. These results and findings support the inclusion of relevant contextual factors in psychological inquiry, and we suggest deliberate inclusion of individuals from all socioeconomic groups in future positive psychological research.

Upstream Factors in Population Health: A Concept Analysis to Advance Nursing Theory

The assessment of upstream factors is important in population-based nursing practice. The aim of this concept analysis is to enhance understanding of upstream factors and articulate a definition linked to the Conceptual Model for Nursing and Population Health. Upstream factors are thus defined as established conditions related to economic, social, and physical environments that occur outside the health care system, in the communities where people live, and contribute indirectly to the health outcomes for groups of individuals through multiple causal pathways. This concept analysis highlights the need for middle-range theory to guide nursing assessment and contributes to conceptual model evaluation.

Civic engagement: School-based health centers and public health nursing

OBJECTIVES

To understand how the events of the 1996 formation of a school-based health center (SBHC) both illustrate the concept of civic engagement and embody historic aspects of public health nursing practice.

DESIGN

Case study design.

SAMPLE

Interviews, documents, epidemiologic records, and field observations.

RESULTS

The three themes discovered were collaboration to achieve public good, equity and social justice, creation of a long-term partnership, and demonstration of leadership using grassroots advocacy.

CONCLUSION

The SBHC case serves as a contemporary example of public health nurses' leadership in the current practice arena. The experience of nurse leadership evokes the historic mission and practice of public health nursing.

Nursing curriculum through a social justice lens: An upstream approach

This article describes a one-day seminar rooted in critical interactionism for nursing students in a diverse urban setting in the United States. The authors are registered nurses and members of Nurses for Social Justice (NSJ)-a loose network of nurses and nursing students committed to societal change. Informed by the history of NSJ and larger social justice movements, the authors intentionally incorporate their personal experiences and offer an example of how nursing education can improve health at the micro and macro levels. The seminar starts with introductions and creating a safe space for authentic engagement. Students are guided to connect with their own journey to nursing and the experiences that have shaped their identities, including being oppressed and privileged. The lack of diversity within the nursing workforce and various nursing roles along the continuum of care are discussed. Case-based scenarios are presented where students explore leveraging their power and privilege to effectively partner with individuals and communities. In closing, lessons learned are shared through a group activity that uses the ecologic model. Recommendations are made to equip nursing students with tools to better understand their role in the broader context of health.

Thinking Upstream: A 25-Year Retrospective and Conceptual Model Aimed at Reducing Health Inequities

Thinking upstream was first introduced into the nursing vernacular in 1990 with the goal of advancing broad and context-rich perspectives of health. Initially invoked as conceptual framing language, upstream precepts were subsequently adopted and adapted by a generation of thoughtful nursing scholars. Their work reduced health inequities by redirecting actions further up etiologic pathways and by emphasizing economic, political, and environmental health determinants. US health care reform has fostered a much broader adoption of upstream language in policy documents. This article includes a semantic exploration of thinking upstream and a new model, the Butterfield Upstream Model for Population Health (BUMP Health).

Effects of Health Insurance Among Patients on Hepatitis C Treatment Along the Texas-Mexico Border

The incidence and prevalence of hepatitis C virus (HCV) is steadily increasing across the world. Increasing morbidity and mortality rates associated with HCV are influencing research on treatment outcomes. The purpose of this project was to examine the effect of health insurance status and office visit compliance on sustained virologic response (SVR) in adult patients living along the Texas-Mexico border treated for HCV and who received dual or triple medication therapy between January 2010 and August 2013. The objective of this project was to determine whether there is an association between health insurance status, and/or office visit compliance, and SVR. We conducted a longitudinal retrospective chart review pilot study of patients who underwent treatment with dual and triple therapy in a border community in Texas. Results revealed that lack of insurance did not affect SVR in the Texas Tech University Health Sciences Center El Paso-based clinic setting due to enrollment into a managed healthcare program. Providing a financial benefit may improve treatment compliance of HCV-infected individuals, reduce overall cost, and improve the patient's quality of life.