chapter 09 population-based public health nursing practice: the intervention wheel

1Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 09

Population-Based Public Health Nursing Practice: The Intervention

Wheel


Objectives

1. Identify the components of the Intervention Wheel.

2. Describe the assumptions underlying the Intervention Wheel.

3. Define the wedges and interventions of the Intervention Wheel.

4. Differentiate among three levels of practice (community, systems, and individual/family).

5. Apply the nursing process at three levels of practice.


The Intervention Wheel Origins and Evolution

Original version resulted from a grounded theory process carried out by public health nurse consultants at the Minnesota Department of Health in the mid-1990s The consultant group presented a series of

workshops across the state highlighting the core functions of public health nursing practice

• Workshop activity required participants to describe the actions they undertook to carry out their work

Adoption of the model was rapid and worldwide


Assumptions Underlying the Intervention Wheel

Assumptions 1 through 10


Assumption 1: Defining PHN Practice

Public health nursing (PHN) is defined as the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences.

The title “PHN” designates a registered nurse with educational preparation in both public health and nursing.

The primary focus is to promote health and prevent disease for entire population groups.


Assumption 2: PHN Practice Focuses on Populations

The focus on populations as opposed to individuals is a key characteristic that differentiates public health nursing from other areas of nursing practice.

Population Population at risk Population of interest


Assumption 3: PHN Practice Considers the Determinants of Health

Health inequities Significant health disparities related to race,

gender, age, and socio-economic status exist within the United States

Determinants of health


Assumption 4: PHN Practice Is Guided by Priorities Identified Through an

Assessment of Community Health Assessment requires on-going collection and

analysis of relevant quantitative and qualitative data

Assessment generally results in a lengthy list of community problems and issues Identify gaps between needs and services


Assumption 5: PHN Practice Emphasizes Prevention

Prevention Levels of prevention

A hallmark of PHN practice is a focus on health promotion and disease prevention, emphasizing primary prevention whenever possible.

Although not every event is preventable, every event has a preventable component.


Assumption 6: PHNs Intervene at All Levels of Practice

To improve population health, the work of PHNs is often carried out sequentially and/or simultaneously at three levels of prevention: Community-level practice Systems-level practice Individual-level practice


Assumption 7: PHN Practice Uses the Nursing Process at All Levels of Practice

Although the components of the nursing process (assessment, diagnosis, planning, implementation, and evaluation) are integral to all nursing practice, PHNs must customize the process to the three levels of practice.


Assumption 8: PHN Practice Uses a Common Set of Interventions Regardless

of Practice Setting The Intervention Wheel encompasses 17

interventions. The interventions are grouped with related

interventions; these wedges are color coordinated to make them more recognizable. The red, green, and blue wedges are mostly used

by nurses focused on individuals, families, classes, and groups.

The orange and yellow wedges are mostly used by nurses focused on effecting systems and communities.


Assumption 9: PHN Practice Contributes to the Achievement of the 10

Essential Services Interventions are the means through which

PHNs implement the 10 essential services


Assumption 10: PHN Practice Is Grounded in a Set of Values and Beliefs

Cornerstones of PHN The Intervention Wheel defines the “what and

how” of PHN practice; the Cornerstones define the “why.”

The Cornerstones synthesize foundational values and beliefs from both public health and nursing.


Using the Intervention Wheel in PHN Practice

The Intervention Wheel is a conceptual model for PHN practice.

The Intervention Wheel provides a framework, a way of thinking about PHN practice.


The Intervention Wheel Components


Components of the Intervetion Wheel

Components 1 through 3


Component 1: The Model Is Population-Based

The upper portion of the Intervention Wheel illustrates that all levels of practice (community, systems, and individual/family) are population-based.

PHN practice identifies populations of interest or populations at risk through an assessment of community health status and an assignment of priorities.


Component 2: The Model Encompasses Three Levels of Practice

Levels of Practice: Community-level Systems-level Individual/family-level

Interventions at each level of practice contribute to the overall goal of improving population health.

The work of PHNs is accomplished at all levels.


Component 3: The Model Identifies and Defines 17 Public Health Interventions

Surveillance Disease and other

health investigation Outreach Screening Case finding Referral and follow-up Case management Delegated functions Health teaching

Consultation Counseling Collaboration Coalition building Community

organizing Advocacy Social marketing Policy

development and enforcement


Applying the Nursing Process at the Individual/Family Level

Community assessment Assessment of a family Diagnosis Planning (Including selection of interventions) Implementation Collaboration Case management Health teaching Delegated functions (PHN to paraprofessional) Referral and follow-up Evaluation


Applying the PHN Process at the Community Level of Practice Scenario

Community assessment (PHN process: assessment) Community diagnosis (PHN process: diagnosis) Community action plan (PHN process: planning,

including selection of interventions) Menu changes Classroom activities Family involvement Community implementation plan (PHN process:

implementation) Community evaluation (PHN process: evaluation)


Applying the PHN Process to a Systems Level of Practice Scenario

Assessment Diagnosis Planning (Including selection of interventions) Implementation Consultation Referral and follow-up Advocacy Policy development Surveillance Evaluation

chapter 09 population-based public health nursing practice: the intervention wheel

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