Nursing’s Role in Population Based Issues



Public Health Nursing: Improving Breastfeeding Rates in Kent CountySuzanne M. SchlachtFerris State UniversityAbstractDespite evidence based data which demonstrates the health benefits to mothers and infants Kent County has a low rate of breastfeeding when compared to national and state averages. Utilizing educational strategies and implementing an expansion of community support, nursing professionals can play an integral role in improving the rates of mothers who breastfeed their infants. Community change requires a team of public nurses at both the direct contact and leadership levels. Although both roles are unique each ultimately compliments and supports the other. Keywords: public health, nurse leader, community nurse roles, Kent CountyPublic Health Nursing: Improving Breastfeeding Rates in Kent CountyThe author is a group member of a community change proposal which aims to improve the number of woman in Kent County who breastfeed their infants. To accomplish the task multiple community agencies will need to collaborate to achieve a common goal. An identified agency which is currently active in breastfeeding awareness and community behavior change is the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The nurse working within this agency has direct contact with the target population of low income pregnant woman. Although many changes can occur through direct contact, long term changes which affect the population are needed at a higher level. A nurse working at the state level as the Chief Nurse Executive would have a leadership role which could institute institutional and state policy changes. The Chief Nurse Executive could also lead media campaigns to increase an awareness of the importance of breast feeding targeting the community utilizing primary, secondary and tertiary prevention strategies. Women, Infants and Children (WIC)Direct Contact NurseWhat is WIC?The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides education, supplemental nutritious food and healthcare referrals for over 9.2 million Americans (Institute of Medicine, 2011). The primary focus group is low-income pregnant, breastfeeding and non-breastfeeding postpartum mothers and children up to the age of five who are identified to be at risk for nutritional deficits. The WIC program was initiated in the 1970’s and presently “serves 53% of all infants born in the United States” (United States Department of Agriculture, 2012). To align with identified goals of improving the status of nutrition and health in infants a breastfeeding campaign was launched by the United States Department of Agriculture, Food and Nutrition Services in 1997. The campaign identifies the healthcare system, family and community support as essential collaborative components to successful breastfeeding strategies in public health (United States Department of Agriculture, 2010). WIC as a Community Change AgencyThe goals stated in Healthy People 2020 are for 75% of mothers to initiate breastfeeding, in all population groups (U.S. Department of Health and Human Services, 2012). Data from the Michigan Department of Community Health (2010) reveals 34.6% of woman plan or initiate breastfeeding. The statistics are even lower in Kent County with only 23.8%.An evidence based identifiable key determinant to breastfeeding behavior is found in the characteristics of mothers who utilize WIC services. A study done which evaluated economic characteristics of mothers who did or did not breast fed was done in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The study demonstrated mothers who used the WIC program were less likely to breast feed (Michigan Department of Community Health, 2011)WIC Nurse RoleAn assessment of Kent County statistical data available at Michigan Department of Community Health website (2010) reveals 40.3% of pregnant women used WIC food and services during pregnancy. Breastfeeding data from Kent County WIC agencies reveals only 21% of infants participating in the program are breastfed. The remaining 79% are fully formula fed despite the evidence based health benefits for mother and child (United States Department of Agriculture, 2010, p.38). This demonstrates a statistically large percentage of potential gains with clients which the nurse has direct contact with. Further community assessment would be needed to determine the full opportunity in this population group as no data is available specific to Kent County regarding community knowledge of eligibility, and those who were eligible but do not utilize the services. Evidence based data identifies pregnant women who utilize WIC services are less likely to initiate or continue to breastfeed their infants. This data provides a target population for the public health nurse working within the WIC agency. While the target population will have a common factor of low income status there will also be multiple variables such as age, race and education level which could potentially affect the educational methods and materials. The public health care nurse would be required to form a team of racially diverse members. It would be also be important to recognize education would have to occur in a manner that is suitable for all literacy levels in the target population. Educational tools could include pamphlets and posters available in the WIC office, high schools, colleges, health clinics and community centers. Demonstrating competence in health care technology the direct care nurse could incorporate current available educational resources into intervention plans. Utilizing existing education tools demonstrates an awareness of fiscal responsibility as well respect for evidence based best practice.An additional identified barrier to breastfeeding initiation and sustainment is the availability of professional and personal support available to a pregnant and postpartum woman. The direct contact public health nurse recognizes the community as a partner. The WIC nurse could collaborate with area LaLeche groups and hospitals in Kent County to identify community resources available to breastfeeding mothers (Centers for Disease Control & Prevention, 2009).Leadership TraitsThe public health nurse working within the WIC agency may not possess a formal leadership job title. However, there are many leadership behaviors and qualities which are necessary in the position. The nurse must possess proficient assessment skills and an ability to analyze data sets. Strong assessment skills provide the public health nurse with the ability to recognize public health concerns as well as the proficiency to establish measurable evidence that implementation plans have or have not been effective. The public health nurse recognizes the importance of evidence based practice when developing and implementing action plans. The public health nurse is an advocate for the community. Working as a group member towards a common goal the nurse must be proficient and professional in communication skills. The public health nurse must form a work group of other professionals working within the agency to meet educational and support goals specific to breastfeeding. The public health nurse must also recognize the importance of collaboration with WIC clients and community members. The public health nurse must possess knowledge of the cultural variances in the targeted population and demonstrate an ability to work respectively in a team setting (American Association of Colleges of Nurses, 2007). ANA Standards of Professional PracticeThe leadership traits necessary for the public health nurse position within the WIC agency are congruent with the characteristics identified by the ANA Standards of Professional Practice (Harkness & DeMarco, 2012, p. 9). The WIC nurse would demonstrate proficiency and knowledge in the ability to identify a problem utilizing a variety of data which supports analytical assessment. As a member of a team, the public health nurse must demonstrate the ability to analyze data and formulate a plan. Utilizing proficient, effective communication skills the public health nurse must collaborate with other members to develop a plan which would meet the educational needs of the target population demonstrating cultural competency and awareness of the multi-dimensional components of a community. (Harkness & DeMarco, 2012, p. 9).Public Health Nurse LeaderThe foundation to improve breastfeeding is present. Multiple data bases, educational information, videos and support groups are available in literature and on the internet. These data sources need to be available, accessible and utilized throughout the community where change can occur through intervention. Evidence based data reveals breastfeeding is best for the mother and the infant in regards to health benefits. It is cost effective, which is particularly relevant for the targeted population and in a time of economic depression. Yet, breastfeeding remains an idea rather than an ideal. The position of Chief Nurse Executive is a nursing health leadership position which could facilitate an improvement of breastfeeding rates in Kent County as well as throughout the state of Michigan. Chief Nurse Executive Michigan’s Chief Nurse Executive is a position which “focuses on policy and legislation, related to Michigan’s workforce and nursing’s unique ability to address health care in our state” (Michigan Department of Community Health, 2012). The Chief Nurse Executive is a position which could facilitate the execution of community plans to improve the rates of breastfeeding. The Chief Nurse Executive could advocate for federal funding to increase the number of WIC nurses in targeted population areas where breastfeeding initiation is low. The increase in nursing would provide additional resources and opportunities to expand education of breastfeeding benefits as well as provide breastfeeding support to improve the rates of mothers who sustain breastfeeding.The Chief Nurse Executive also has responsibilities in nursing education. In this role the nurse could lobby for breastfeeding promotion education of all nurses who work in Labor and Delivery and Neonatal Intensive Care Units. As a nursing expert the chief nurse executive is in a position to collaborate with media agents to institute a media campaign which has the potential to educate the public on the benefits of breastfeeding for mothers and infants. Leadership TraitsAs a leader, the nurse working at the state level as the Chief Nurse Executive has the expertise and ability to ensure the provision of public health meets the expectations and standards supported by the Centers for Disease Control & Prevention (CDC). The CDC supports breastfeeding and has information to improve and maintain breastfeeding initiatives including Maternity Care Practice recommendations as a standard of care to improve state statistics (Centers for Disease Control & Prevention, 2009). As a leader, the Chief Nurse Executive can coordinate the training and educational requirements of nurses working toward a common goal throughout the state (Association of State and Territorial Directors of Nursing, 2008). The Chief Nurse Executive has the knowledge to assess, implement and evaluate best practice projects supported by the CDC throughout the state. Working as a leader the Chief Nurse Executive can demonstrate cost effective planning and empower public health care teams across the state. Individual public health teams can evaluate resources and develop intervention plans to improve breastfeeding rates. As a recognized expert, the Chief Nurse Executive can bring the data and strategies to state legislatures and identified private support groups to advocate for financial and policy support to assist communities. As a public health care expert the Chief Nurse Executive would realize the community as an entire state and promote primary prevention strategies. Developing an evidence based plan and measurable statistic goals a media campaign could target mothers statewide. Consulting with other experts in the field she could promote community education to increase the awareness of breastfeeding as a state-wide nutrition campaign. ANA Standards of Professional PracticeThe roles and traits of a leader discussed demonstrate a command of the eight domains of public health established by the American Nurses Association (2007) as cited in Harkness & DeMarco (2012, p. 9). The Chief Nurse Executive would utilize knowledge and resources to analyze the scope of the problem and develop a plan to improve community health with the goal of improving breastfeeding rates. Finances are a concern for most public health undertakings. A public health nurse leader knowledgeable about community dimensions could utilize public health nurses who are working within the community and aware of community dynamics to assist in assessment, implementation and evaluation plans. Expert communication skills would be required throughout the project as funding and policy change endeavors will depend on support from legislative and private sponsors. AnalysisThe roles of the direct contact nurse and the nurse leader/manager are similar in many ways. In both roles nurses would work as members of a team to obtain a common goal of improving breastfeeding rates in Kent County. Both roles require effective communication skills. The direct contact nurse must demonstrate competence in speaking, understanding and listening as a public health care team member and as a health care professional for a multicultural population. The nurse leader must demonstrate confidence and knowledge as well as the ability to articulate information when communicating in the government and public arena. Both nurse roles require the ability to analyze and apply data. The direct contact nurse must be knowledgeable about community assessment tools and understand the application of findings to intervention plans. The nurse leader role requires proficiency in data analysis. A nurse leader realizes and recognizes data trends and implements plans which can alter statistics at individual as well as state as a community. To provide education and support for breastfeeding mothers resources must be available during all contact points of care. As a leader the Chief Nurse Executive can affect change in educational requirements for nurses who work with mothers and infants in hospital settings. The direct contact nurse can facilitate knowledge growth in individuals, families and population groups. Providing consistent data which supports the health benefits of breastfeeding can improve breastfeeding rates in small communities such as Kent County as well as in large communities such as the state of Michigan. The public health nurse as a direct contact nurse and the Chief Executive Nurse as nurse leader are both advocates for change. They both recognize the value of health promotion to reduce risk. The nurse leader would adhere to responsibilities throughout the state and work to improve breast feeding statewide, rather than focusing on only one county. As the Chief Nurse Executive, the nurse leader has the legislative power to promote the policies to affect change. Change in education and practice standards would become the tools and resources for the direct contact nurse. Although the roles vary in responsibility, application and expertise together they form a partnership which can improve the health of mothers and infants throughout the state.ReflectionThe author had never considered a position in public health in the past. Following an analysis of skills, knowledge and responsibilities for both positions the author realizes several personal attributes which would be compatible for a role in public health. Over the past 25 years the author has held a number of nursing positions with various roles. The author has experience in education of patients as well as healthcare persons. The author has leadership and management experience as a clinical coordinator and has worked in a variety of settings, with a diversity of population and cultural groups. Currently, the author holds a position in patient safety and quality improvement which has given the author several experiences which would contribute to a role as a public health care nurse. As a member of a process improvement team, the author currently engages in assessment of current processes, identifies best practice utilizing various research tools and develops intervention plans which are efficient, standardized and cost effective. The author also has experience speaking in large public settings and in small settings such as management groups. Although the author has qualities and skills which would be assets in both roles, the writer does not have experiences and expertise in public health which would be required as an advanced practice public health nurse such as the role of Chief Nurse Executive. Additionally, the writer does not possess the educational requirements or years of public health experience which would be required to be an efficient, effective leader in public health such as the role of Chief Nurse Executive. However, a baccalaureate degree in nursing is identified as “the educational credential for entry into public health” (Harkness & DeMarco, 2012, p. 9). The author is actively pursuing a baccalaureate degree and does possess the leadership, analytical skills and experience which could yield an effective, efficient and successful direct contact public health nurse. ReferencesAmerican Association of Colleges of Nursing. (2007).White paper on the education and role of the clinical nurse leader. Retrieved from of State and Territorial Directors of Nursing. (2008).Providing a Peer and Collegial Forum for Public Health Nursing Leadership. Retrieved from Centers for Disease Control and Prevention (2009).CDC Guide to Breastfeeding Interventions: Maternity Care Practices. Retrieved from, G. &DeMarco, R. (2012).Community and public health nursing: Present, past and future. Community and Public Health Nursing: Evidence for Practice, 3-24. Philadelphia, PA: Lippincott Williams & WilkinsInstitute of Medicine. (2011). Updating the USDA national breastfeeding campaign-Workshop summary. Retrieved from Department of Community Health. (2010). Characteristics of the mother or infant, as a percentage of live births Kent county and Michigan residents, 2010.NatalityStatistics. Retrieved from Department of Community Health. (2011, January).Breastfeeding initiation and three months exclusive duration, MI PRAMS 2004-2008.MI PRAMS Delivery, 10 (1). (pp. 1-4). Retrieved from Department of Community Health.(2012).What does the chief nurse executive do? Retrieved at States Department of Agriculture, Food and Nutrition Services. (2010). WIC Breastfeeding Data Local Agency Report.(pp. 1-38). Retrieved from States Department of Agriculture, Food and Nutrition Services. (2012). About WIC. Retrieved from States Department of Health and Human Services. (2012).Maternal, infant and child health. Healthy : 2020 Topics and Objectives. Retrieved from ................
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