Nursing’s Leadership Roles in Population Issues



Nursing’s Leadership Roles in Population Issues

Adrianne Tozer

Ferris State University

Nursing’s Leadership Roles in Population Issues

The purpose of this paper is to show the roles community health nurses play in preventing the spread of sexually transmitted diseases (STDs) among adolescent females. Sexually transmitted diseases have been an ongoing public health concern and financial burden for many years. According to the Centers for Disease Control and Prevention (CDC), “there are approximately 19 million new STD infections each year-almost half of them among young people ages 15-24” (U.S. Department of Health & Human Services, 2013, para 3). Many STDs have severe health consequences such as cancer, infertility and even death. Unfortunately, women suffer theses complications more than men (U.S. Department of Health & Human Services, 2013). This is precisely why community health nurses should focus on STD prevention among adolescent females. Nurses in this role have an opportunity to advocate, educate and use their power to influence others in order to decrease the prevalence of STDs throughout communities. This can be accomplished in two distinct ways. The first role is the direct approach in which the nurse focuses primarily on an individual and the second is the indirect approach whereas the nurse focuses on a specific population.

Direct Contact Nurse Role

Any given community throughout the United States affected by the prevalence of STDs among adolescent females. However, there is a fortunate side in that many health departments offer clinics. One effective direct nursing role would be providing STD counseling and testing to female adolescents at the community health department. This allows the nurse to interact with the individual, in a private setting. There is a taboo and shame associated with STDs so it is important the nurse is nonjudgmental in order for the client to provide honest information or else the outcome will be negative. The interview process can be a challenge for both patient and nurse due to sexuality and intimacy issues. Once the nurse is able to demonstrate professionalism the client will be receptive to answering questions and education. The nurse has a chance to offer a general overview of STDs, prevention strategies, testing and treatment options. This type of counseling is client-centered and involves individualizing the education and discussion. This will increase the probability the patient adheres to risk-reduction practices, especially among those seeking STD care (Centers for Disease Control & Prevention, 2010).

Leadership Role and Characteristics

In order for the nurse to function in this direct patient role she must exhibit strong leadership roles. One essential way the nurse can lead is by advocating for the need, services and benefits the clinic provides to the community. First, in order for the clinic to be successful the public must be aware the service exists. The nurse can accomplish this by speaking with schools, churches, youth groups, physicians and local hospitals. This will serve two purposes. First, this becomes a form of advertisement, especially for the target population and secondly, generates potential referrals to the clinic. The nurse will also use this opportunity to build relationships with community members and local health organizations which can lead to donations and financial support for the continuation of the service. This entails strong communication skills, relationship building and motivation. According to Adams (2010) building relationships, communicating and negotiating effectively are the most important skills any leader should have. However, the community nurse realizes the hard work serves a greater purpose.

Standards of Professional Practice

Public health nurses have unique opportunities to impact the health of a large number of people but in order to do so she must adhere to professional standards set forth by the American Nurses Association (ANA). Of course, each standard should be reflected throughout any nurse’s practice. However, one standard which is imperative to the public health nurse working in a direct contact role is ethics. According to the ANA, “The public health nurse deliver programs and services in a manner that preserves, promotes, and protects the autonomy, beliefs, dignity, values, and rights of individuals, communities, and populations” (American Nurses Association, 2013, p. 44). Sexually transmitted diseases are a sensitive topic to discuss, especially with adolescents. Practicing in an ethical manner such as maintaining boundaries, abiding my HIPPA (Health Insurance Portability and Accountability Act) laws and allowing members of the community to make informed decisions are all ways in which the nurse can be effective in promoting the health of others.

A second standard in public health nursing which stands out above the rest is evidence-based practice and research. According to the ANA (2013), “The public health nurse utilizes the best current evidence, including nursing and public health research findings, to guide practice, policy, and service delivery decisions” (p. 48). Often the public health nurse works independently and receives little monitoring from others so she must be well versed in the latest research to guide her practice. A nurse dealing directly with STDs also has the opportunity participate in data collection such as gathering statistics and sharing them with public health officials in an effort to make future improvements.

Indirect Nurse Role

An indirect community nursing role includes many duties but none are as important as providing broad public education. One avenue the community health nurse can take to disseminate information about STDs would entail developing an educational program for middle and high school female students. The topics would include prevention, transmission, signs and symptoms, testing and treatment. According to The Henry J. Kaiser Family Foundation, teens are at a greater risk for STDs related to behavioral, biological and cultural factors (2013). “Primary prevention of STDs begins with changing the sexual behaviors that place persons at risk for infection” (Centers for Disease Control and Prevention, 2010, para 1). It is for this exact reason teaching should take place in the school setting since it is cost effect and addresses a large body of the target population.

Leadership Roles and Characteristics

The leadership role which most embodies this particular community nurse role is empowerment. The nurse is creating a program which empowers females to take control of their bodies and health. Promoting sexual and reproductive health to young impressionable adolescents will have long term, positive effects on the community. Mentoring other nurses who work in community by sharing clinical experiences and skills is another form of empowerment the nurse can offer. Some characteristics seen in those who empower others is confidence, positive attitude, encouraging nature and a nonjudgmental stance. All of these characteristics are then passed onto others which will promote health and wellness in the community.

Standards of Professional Practice

One standard which is significant to developing an educational program on STDs would be communication. According to the ANA (2013), “The public health nurse conveys information to individuals, families, groups, communities, populations, and interprofessional colleagues in communication formats that promote accuracy, evidence-based practice, and awareness of health literacy” (p. 52). For example, when setting up the program the nurse will need to communicate with other members of the community as to why such a program is needed along with the benefits. Without powerful communication skills the project could fall on deaf ears. It is also essential the nurse understands the importance of adapting her communication style according to the audience. For example, how she speaks with school officials, teachers and other healthcare providers will not be the way she discusses STDS with female adolescents. It is important to remain cognitive of the audience you are communicating with or barriers could form.

Another important standard strongly related to the indirect nurse role is that of leadership. According to the ANA (2013), “The public health nurse facilitates development of organizational plans to implement programs and policies” (p. 54). The nurse will also be responsible for measuring the effectiveness of the educational program and communicating the outcomes to community officials, in order to receive continued ongoing support. The nurse must uphold the programs mission and vision while encourage other healthcare members to do the same. Mentoring is also involved because the nurse will need to lend guidance, direct and support other team members helping to run the program.

Analysis

Both the direct and indirect roles of the community health nurse are equally important; however there are some clear differences, as well as, similarities. The indirect role centers on primary care which involves a proactive approach through education. The direct role does provide primary prevention but a strong focus is placed on secondary prevention which revolves around identifying and treating patients. For example, the STD clinic nurse identifies high risk behaviors in those who are coming to the center for testing and possible treatment. Another difference is patient privacy in a clinic setting versus a large educational group. A patient who visits the clinic will be required to reveal their health history and requires a private setting. However, the indirect role involves a nurse speaking in general terms to an audience. In this setting no personal health information is revealed. It is important to note, regardless of the nurse role, education is the key player at all levels of community health. Whether it is educating about prevention, risk reduction, treatments and testing to the public or educating health officials on the statistics of STDs in the community.

Political Arena

Nurses can help to make community health changes by influencing public policy. “Although elected officials frequently are tasked with taking positions on various healthcare proposals, it is nurses who understand healthcare issues and trusted by patients and the public” (Maryland & Gonzalez, 2012, para 3). For example, both the direct and indirect community health nurses are able to see first hand the need for STD education. Educating a large number of people, running a clinical and developing a school based educational program can cost a huge sum of money. Often communities do not have the financial resources to initiate or maintain these programs. However, the nurse can help influence public debate about healthcare resource distribution (Maryland & Gonzalez, 2012).

Nurses can also assist in making changes in the educational system. For example, the nurse involved in developing the STD educational program for adolescent girls may feel sex education classes need to be integrated into the school curriculum or she may feel a full time school nurse is needed to better meet the health needs of adolescents. In turn the nurse can bring facts and data supporting her request to the school board, principal, teachers and parents. By educating the appropriate people on health care issues she can gain the needed resources to make changes.

Implications of Needed Skills

The skills needed for a community health nurse are gained through education. For many years arguments have been made about educational standards of nurses, however, healthcare is growing complex so nurses need advanced education. Improved patient outcomes have been linked to having increased baccalaureate prepared nurses in the work force. “This broader knowledge base includes the creative decision-making, critical-thinking, and managerial skills needed for dealing with a diverse and multicultural workforce and patient population” (Smith, 2010, para 1). Of course, experience and individual motivation play a large part in acquiring the skills needed to work as a community health nurse but education is paramount. However, it is important once a degree is earned, life long learning steps in. The nurse must stay up-to-date on evidence-based research, political changes and technology in order remain effective. This can be accomplished through continuing education classes, reading nursing journals and returning to school to earn advanced degrees.

Reflection

My communication skills would best serve in the role of direct care. On a day to day basis I deal directly with individual families. I can easily adapt my communication according to the needs of the patient. For example, some patients require a longer time understanding a teaching point and may require a simplified explanation. Other patients catch on easily and actually prefer me to be specific/detailed in the teaching. I teach cardio-pulmonary resuscitation (CPR) for the American Red Cross so I have experience speaking in front of large groups, which is beneficial for the role of indirect nurse. However, advocating for policy change and financial assistance would be the most challenging for me no matter what role. I find it difficult to be assertive and prefer to quietly go about my daily work. A community nurse dealing with STDs may face oppossion from parents, teachers and school officials who feel this type of education is not appropriate in the schools. I find it difficult to stay strong during confrontation and oppossion and tend to give up to quickly. The best way to improve my competence is through continued education and community volunteerism; both of which I am currently partaking in.

Community health nurses have enormous opportunities to improve the lives of people on many levels. It could be small like providing an adolescent information on STDs or a large undertaking such as advocating to make state or national health changes. What ever the direction is chosen it takes strong communication and leadership skill in order to make your voice heard in order to empower the people you serve.

References

American Nurses Association [ANA]. (2010). Nursing: Scope and standards of practice (2nd ed.). Retrieved from hppt:/​/​​ebooks/​download/​NursingScopeStandards.pdf

American Nurses Association. (2013). Public health nursing: scope and standards of practice (2nd ed.). Retrieved from http:/​/​​ebooks/​download/​Public-Health-Nursing2nd.pdf

Centers for Disease Control, & Prevention. (2010). Clinical prevention guidance. Retrieved from http:/​/​​std/​treatment/​2010/​clinical.htm

The Henery J. Kaiser Family Foundation. (2013). Sexual health of adolescents and young adults in the United States [Fact sheet]. Retrieved from http:/​/​​womens-health-policy/​fact-sheet/​sexual-health-of-adolescents-and-young-adults-in-the-united states/​

Maryland, M. A., & Gonzalez, R. I. (2012). Patient advocacy in the community and legislative arena. OJIN: The Online Journal of Issues in Nursing, 17(1). doi:10.3912/​OJIN.Vol17No01Man02

Smith, T. G. (2010). A policy perspective on the entry into practice issue. OJIN: The Online Journal of Issues in Nursing, 15(1). doi:10.3912/​OJIN.Vol15No01PPT01

U.S. Department of Health, & Human Services. (2013). Sexually transmitted diseases. Retrieved from Web site: http:/​/​​2020/​topicsobjectives2020/​overview.aspx?topicid=37

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