We are comparing and contrasting epidemiological methods of research; case-control and cohort study methods. Select either the case-control or cohort study method and compare its fea

Concepts and Competencies for Advanced Practice

A N N L . C U P P C U R L E Y EDITOR

C U

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E Y

PRAISE FOR THE FIRST EDITION:

“…nicely integrates epidemiological concepts, evidence-based practice in population health, and program development and evaluation…Authors describe epidemiological research designs, research synthesis, and evidence assessment—knowledge essential for advanced practice nurses working with populations or in the community.”

—Journal of Community Health Nursing

In its third edition, Population-Based Nursing continues to be the only advanced practice nursing text to focus on core competencies in both epidemiology and population health. This comprehensive

resource delivers essential content for doctoral nursing practice (as outlined by the AACN) and encompasses the many changes in healthcare that affect population-based nursing. It describes the role of the advanced practice nurse in identifying and mitigating healthcare disparities at the local, national, and global levels and provides guidance on how to conduct community assessments. A strong foundation in epidemiologic methodology is provided, including coverage of mortality measures, testing validity and reliability, study designs, risk and casualty assessment, and data analysis and interpretation.

Updated throughout, the third edition includes new and expanded topics such as the role of accreditation in validating population-based practice and programs; value-based care; and the use of technology, data, and information systems in population health. The text includes links to online resources and a robust Instructor’s Manual with exercises and discussion questions. In addition to its value as a primary textbook in DNP and MSN programs, the text also serves as valuable resource for advanced practice nursing professionals.

KEY FEATURES:

• Includes a strong focus on both epidemiology and population-based nursing competencies

• Addresses the Essentials of Doctoral Education for Advanced Nursing Practice as outlined by the AACN

• Includes new and expanded topics such as the role of accreditation in validating population- based practice and programs; value-based care; and the use of technology, data, and information systems in population health

• Examines how technological innovation and social networking impact the development of interventions and population outcomes

• Provides links to online resources and a robust Instructor’s Manual with exercises and discussion questions

• Purchase includes access to the ebook for use on most mobile devices or computers

THIRD EDITION

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POPULATION-BASED

NURSING

Concepts and Competencies for Advanced Practice

A N N L . C U P P C U R L E Y, PhD, RN, Editor

THIRD EDITION

POPULATION-BASED NURSING

P O

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IN G

11 W. 42nd Street New York, NY 10036-8002 www.springerpub.com

9 780826 136732

ISBN 978-0-8261-3673-2

POPULATION-BASED NURSING

Ann L. Cupp Curley, PhD, RN, recently retired from her position as the Nurse Research Specialist at Capital Health in Trenton, New Jersey, where she was responsible for pro- moting and guiding the development of nursing research and evidence-based practice. She has an extensive background in nursing education at the undergraduate, graduate, and doctoral levels, and more than 10 years’ experience in community and public health nursing. Dr. Curley has been principal or co-principal investigator of many research proj- ects and continues to serve as an advisor on DNP project committees and a research con- sultant. She received a BSN from Boston College, an MSN in community health/clinical nurse specialist track from the University of Pennsylvania, and a PhD in urban planning and policy development from Rutgers, Th e State University of New Jersey. Dr. Curley has received many honors, including the Nurse.com Nursing Spectrum Excellence Award for Education and Mentorship.

POPULATION-BASED NURSING

CONCEPTS AND COMPETENCIES FOR ADVANCED PRACTICE

Third Edition

Ann L. Cupp Curley, PhD, RN Editor

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ISBN: 978-0-8261-3673-2 ebook ISBN: 978-0-8261-3674-9 Instructor’s Manual: 978-0-8261-3675-6 DOI: 10.1891/9780826136749

Instructor’s Materials: Qualifi ed instructors may request supplements by emailing [email protected] com.

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In Memory of Patty Vitale

Good friends are hard to fi nd . . . and impossible to forget. —Anonymous

CONTENTS

Contributors xi Foreword Patricia A. Polansky, RN, MS xiii Preface xv Acknowledgments xxi

1. Introduction to Population-Based Nursing 1 Ann L. Cupp Curley

Introduction 1 Background 2 Defi ning Populations 6 Using Data to Target Populations and Aggregates at Risk 7 Summary 17 Exercises and Discussion Questions 18 References 19 Internet Resources 22

2. Identifying Outcomes in Population-Based Nursing 25 Alyssa Erikson and Sonda M. Oppewal

Introduction 25 Identifying and Defi ning Population Outcomes 26 National Healthcare Objectives 37 Summary 45 Exercises and Discussion Questions 46 References 47 Internet Resources 50

3. Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part I 53 Patty A. Vitale and Ann L. Cupp Curley

Introduction 53 Th e Natural History of Disease 54 Prevention 55 Causation 57 Methods of Analysis 58 Descriptive Studies 72

Share Population-Based Nursing

viii CONTENTS

Analytic Epidemiology 74 Summary 81 Exercises and Discussion Questions 82 References 85 Internet Resources 86

4. Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part II 87 Patty A. Vitale and Ann L. Cupp Curley

Introduction 87 Errors in Measurement 87 Confounding 92 Interaction 93 Randomization 94 Data Collection 95 Causality 96 Scientifi c Misconduct (Fraud) 97 Study Designs 98 Databases 102 Summary 104 Exercises and Discussion Questions 104 References 106 Internet Resources 107

5. Applying Evidence at the Population Level 109 Vera Kunte and Ann L. Cupp Curley

Introduction 109 Asking the Clinical Question 110 Th e Literature Review 114 Assessing the Evidence 117 Integration of Evidence Into Practice 128 Summary 133 Exercises and Discussion Questions 134 References 134 Internet Resources 137

6. Using Information Technology to Improve Population Outcomes 139 Laura P. Rossi and Ann L. Cupp Curley

Introduction 139 Use of the Internet to Obtain Health Information 140 Using Technology to Improve Population Health 146 E-Resources Th at Support Population-Based Nursing 150

CONTENTS ix

Summary 154 Exercises and Discussion Questions 155 References 155

7. Concepts in Program Design and Development 159 Laura P. Rossi and Ann L. Cupp Curley

Introduction 159 Sources of Data 159 Innovative Care Delivery Models 162 Program Development: Where to Start 163 Implementation 172 Overcoming Barriers and Challenges 178 Summary 180 Exercises and Discussion Questions 180 References 181 Internet Resources 182

8. Evaluation of Practice at the Population Level 183 Barbara A. Niedz

Introduction 183 Monitoring Healthcare Quality 184 Summary 210 Exercises and Discussion Questions 211 References 212 Internet Resources 216

9. Th e Role of Accreditation in Validating Population-Based Practice/Programs 219 Eileen M. Horton

Introduction 219 Governmental Programs 222 Non-Governmental Programs 227 Planning for Accreditation 231 Summary 233 Exercises and Discussion Questions 233 References 234 Internet Resources 235

10. Building Relationships and Engaging Communities Th rough Collaboration 237 Sonda M. Oppewal and Barbara A. Benjamin

Introduction 237 Foundation for Population-Focused Practice 237

x CONTENTS

Community Health Assessment 242 Assessment Tools and Methods 246 Building Relationships 254 Summary 257 Exercises and Discussion Questions 258 References 259 Internet Resources 261

11. Challenges in Program Implementation 263 Janna L. Dieckmann

Introduction 263 Lewin’s Stages of Change 264 Community Engagement 265 Summary 285 Exercises and Discussion Questions 285 References 286 Internet Resources 288

12. Implications of Global Health in Population-Based Nursing 289 Lucille A. Joel and Irina McKeehan Campbell

Core Competencies in Global Health 289 Summary 314 Exercises and Discussion Questions 314 References 315 Internet Resources 317

Index 319

CONTRIBUTORS

Barbara A. Benjamin, EdD, RN, Adjunct Faculty, University of North Carolina, Chapel Hill

Irina McKeehan Campbell, PhD, MPH, Professor, Department of Health Sciences, School of Health and Human Services, National University, La Jolla, California

Ann L. Cupp Curley, PhD, RN, Research Consultant, Falmouth, Massachusetts

Janna L. Dieckmann, PhD, RN, Clinical Associate Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Alyssa Erikson, PhD, MSN, RN, Associate Professor and Chair, Department of Nursing, California State University Monterey Bay, Seaside, California

Eileen M. Horton, MSN, MSM, RN, NEA-BC, Senior Vice President, Hospital Adminstration and Chief Quality Offi cer (retired), Capital Health, Trenton, New Jersey

Lucille A. Joel, APN, EdD, FAAN, Distinguished Professor, Rutgers University School of Nursing, Newark, New Jersey

Vera Kunte, DNP, APN, Nurse Research Specialist, Capital Health, Trenton, New Jersey

Barbara A. Niedz, PhD, RN, CPHQ, Assistant Professor, Rutgers University, School of Nursing, Newark, New Jersey

Sonda M. Oppewal, PhD, RN, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Laura P. Rossi, RN, PhD, Assistant Professor, Simmons University, College of Natural, Health and Behavioral Sciences, School of Nursing; Program Manager, Quality and Patient Safety, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts

Patty A. Vitale†, MD, MPH, FAAP

† Deceased

FOREWORD

“What’s past is prologue,” wrote William Shakespeare in Th e Tempest. Why read Population-Based Nursing: Concepts and Competencies for Advanced Practice? In this book, the third edition, there is a lot more to know and learn. If the fi rst two decades of the 21st century have taught us anything it is that what we know as healthcare is changing at warp speed. And, as the anniversary of Florence Nightingale’s 200th birthday looms large, Shakespeare’s words echo in our ears and remind us of needed changes in the practice of the profession of nursing. We inherently know that what has happened in the past sets the scene for the really important morphs yet to be identifi ed and implemented. Th ose changes will determine nursing’s viability in the ever chang- ing national and global health marketplace.

While as in the fi rst and second editions successful strategies that nurses have used to improve population outcomes are paramount, the readers will discover new infor- mation in the third edition on how to identify healthcare needs at the population level and how to improve overall population outcomes. Voila. Not only that, but intro- duction of the most common study designs and successful program implementation strategies will lead you to correct design selection, successful implementation and most importantly overall success. Problem solved!

Th e third edition charts a path toward understanding how to successfully integrate new knowledge into practice. Th is, as experience teaches us, is no small task. Chapter 6 actually describes how technology can be used to truly enhance population-based nursing and describes the role and importance of APRNs in using data to make deci- sions that lead to new levels of program development and evaluation. While Clara Barton and Florence Nightingale did not have AI they understood that statistics are needed to measure outcomes. Chapter 8 identifi es ways and means to evaluate pop- ulation outcomes and systems changes. Th ese concepts and roles are explored within the competencies of the APRN. Th e healthcare marketplace is extremely competitive, and executives and managers are like radar screens looking to identify opportunities to distinguish and validate their organizations. Th is book helps the new APRN iden- tify the ways and means to achieve such validation.

Nurses need to be part of the highest level of care management and policy decision making in partnership with healthcare policy brokers and healthcare policy makers. In Chapter 10, the emphasis is placed on identifying community needs and assess- ment of resources. Chapter 11 rounds up by providing specifi c strategies for program implementation coupled with methods to empower the community to advocate for themselves. In the fi nal chapter global health and cultural issue for population-based

xiv FOREWORD

nursing theory and practice open one’s eyes to recent patterns in international interdis- ciplinary collaborations including the latest global health competencies. A primer for all practitioners whatever the setting.

Th is edition targets all of the important aspects in population-based care for the most trusted and recognized of all healthcare professions. Nursing remains, and should remain, a practice centered and caring profession, but current times mandate that nurses discover new and eff ective strategies for promoting health and providing care. Th is book gives nurses everything from A to Z describing the role of the APRN in the accreditation process to zeroing in how to eliminate health disparities. By looking back to the lessons and wisdom of the past and opening our minds to the new vistas and parameters of pop- ulations and the potential impact of a population-based approach to care it charts the ways and means toward the future. . ., which is now. Th e past is prologue.

Th ese are nursing’s new Tools of the Trade.

Patricia A. Polansky, RN, MS Director, Program Development and Implementation

Center to Champion Nursing in America RWJF/AARP

Washington, DC

PREFACE

My good friend, colleague, and co-editor Patty Vitale died shortly aft er we completed the planning for this, the third edition of our book. Patty had enormous energy and zest. Both fi guratively and literally she danced her way through life. Th e joy that she exuded on the dance fl oor was a refl ection of the joy that she had for living. She was dedicated to making the world a better place for children through her work as a pedi- atrician and an educator. Th is book is part of the enduring legacy that she left behind.

Th e original inspiration for this book grew out of our experience while co-teach- ing an epidemiology course for students enrolled in a doctorate in nursing practice (DNP) program. We found it diffi cult to fi nd a textbook that addressed the course objectives and was relevant to nursing practice. We decided a population-based nurs- ing textbook, targeted for use as a primary course textbook in a DNP program or as a supplement to other course materials in a graduate community health nursing pro- gram, would be of great benefi t and value to students enrolled in these programs. Th is book is the result of that vision. Th e chapters address the essential areas of content for a DNP program as recommended by the American Association of Colleges of Nursing (AACN), with a focus on the AACN core competencies for population-based nurs- ing. Th e primary audience for this text is nursing students enrolled in either a DNP program or a graduate community health nursing program. Each chapter includes discussion questions to help students use and apply their newly acquired skills from each chapter.

In this book, the third edition, our goals were to not only update the content of the existing chapters, but also add a chapter on accreditation of population-based programs. We were fortunate that a nurse with extensive experience in accreditation (Eileen Horton) agreed to write the chapter for us. In order to make it easier for read- ers to enhance their knowledge of the information that is covered in the book, we also decided to add a relevant list of Internet resources to each chapter.

Several events covering a wide range of issues in the healthcare fi eld have occurred over the past few years. Th ese include the attempts by the Trump administration to dismantle the Aff ordable Care Act and eff orts by the 116th Congress to expand the role of public programs in healthcare. Bills being introduced in the House range in scope from broad proposals to create a new national health insurance program for all residents (oft en referred to as “Medicare for All”) to more incremental approaches that would off er a public plan option in addition to current sources of coverage. It appears that the 2020 elections may well turn into a referendum on healthcare and how it should be paid for. States and local governments are increasingly turning to

xvi PREFACE

legislation in an attempt to quell outbreaks of measles. As of April 2019, offi cials at the Centers for Disease Control and Prevention (CDC) had confi rmed 695 measles cases across 22 states for the current year, a record high since the disease was thought to have been eliminated in the United States in 2000. According to a UNICEF report, among high-income nations, the United States had the most children who went unvaccinated between 2010 and 2017 (CDC, 2019). Th ere is increasing concern over the usage of elec- tronic cigarettes and hookahs by children. Th ere is also increasing interest in the use of social media to address population health. Th is edition addresses these as well as other current issues in population-based nursing.

As in the fi rst and second editions, this textbook includes successful strategies that nurses have used to improve population outcomes and reinforces high-level applica- tion of activities that require the synthesis and integration of information learned. Th e goal is to provide readers with information that will help them to identify healthcare needs at the population level and improve population outcomes. In particular, Chapter 1, Introduction to Population-Based Nursing, introduces the concept of population-based nursing and discusses examples of successful approaches and interventions to improve population health. In this edition we use the title “advanced practice registered nurse” (APRN). APRN is the title used in Th e Consensus Model for APRN Regulation, Licensure, Accreditation, Certifi cation and Education (APRN Consensus Workgroup & National Council of State Boards of Nursing APRN Advisory Committee, 2008). Th is document is the product of the APRN Consensus Work Group and the National Council of State Boards of Nursing (NCSBN).

In order to design, implement, and evaluate interventions that improve the health of populations and aggregates, APRNs need to be able to identify and target outcome measures. Chapter 2, Identifying Outcomes in Population-Based Nursing, explains how to defi ne, categorize, and identify population outcomes using specifi c examples from practice settings. Th e identifi cation of outcomes or key health indicators is an essential fi rst step in planning eff ective interventions and is a requirement for evaluation. Th e chapter includes a discussion of nurse-sensitive indicators, Healthy People 2020, Healthy People 2030, national health objectives, and health disparities. Emphasis is on the identi- fi cation of healthcare disparities and approaches that can be used to eliminate or mitigate them. APRNs can advocate needed change at local, regional, state, or national levels by identifying areas for improvement in practice, by comparing evidence needed for eff ec- tive practice, and by better understanding health disparities. APRNs have an important collaborative role with professionals from other disciplines and community members to work toward eliminating health disparities.

Epidemiology is the basic science of prevention (Gordis, 2014). Evidence-based prac- tice, as it relates to population-based nursing, combines clinical practice and public health through the use of population health sciences in clinical practice (Heller & Page, 2002). Programs or interventions that are designed by APRNs should be evaluated and assessed for their eff ectiveness and ability to change or improve outcomes. Th is is true at an individual or population level. Data from these programs should be collected system- atically and in such a manner that can be replicated in future programs. Data collection

PREFACE xvii

must be organized and analyzed using clearly defi ned outcomes developed early in the planning process. Best practice requires that data are not just collected; data must also be analyzed, interpreted correctly, and, if signifi cant, put into practice. Understanding how to interpret and report data accurately is critical as it sets up the foundation for evi- dence-based practice. With that said, it is important to understand the basics of how to measure disease or outcomes, how to present these measures, and to know what types of measures are needed to analyze a project or intervention.

Chapter 3, Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part I, describes the natural history of disease and concepts that are integral to the prevention and recognition (e.g., screening) of disease. Basic concepts that are neces- sary to understand how to measure disease, and design studies that are used in popula- tion-based research, are discussed. Disease measures, such as incidence, prevalence, and mortality rates, are covered, and their relevance to practice is discussed. Th is chapter also includes information on primary, secondary, and tertiary prevention, and the concept of causality is introduced. A section on survival and prognosis is included. Th is material broadens the knowledge of readers with information necessary for advanced practice and interpretation of survival data. Th e basics of data analysis, including the calculation of relative risk, attributable risk, and odds ratio, are presented with examples of how to use these measures. Study design selection is an important part of the planning pro- cess for implementing a program. A portion of Chapter 3, Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part I, is dedicated to introducing the most common study designs, because correct design selection is an essential part of sound methodology, successful program implementation, and overall success.

In order for APRNs to lead the fi eld of evidence-based practice, it is critical that they possess skills in analytic methods to identify population trends and evaluate outcomes and systems of care (American Association of Colleges of Nursing [AACN], 2006). Th ey need to carry out studies with strong methodology and be cognizant of factors that can aff ect study results. Identifi cation and early recognition of factors that can aff ect the results or outcomes of a study, such as systematic errors (e.g., bias), should be acknowl- edged because they cannot always be prevented. In Chapter 4, Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part II, the APRN is intro- duced to the elements of bias with a comprehensive discussion of the complexities of data collection and the fundamentals of developing a database. More in-depth discus- sion of study designs is covered, as well as a comprehensive review of ways to report on randomized and nonrandomized studies. Critical components of data analysis are discussed, including causality, confounding, and interaction.

In order to provide care at an advanced level, nurses must incorporate the con- cepts and competencies of advanced practice into their daily practice. Th is requires that APRNs acquire the knowledge, tools, and resources to know when and how to integrate them into practice. In Chapter 5, Applying Evidence at the Population Level, the APRN learns how to integrate and synthesize information in order to design inter- ventions that are based on evidence to improve population outcomes. Nurses require several skills to become practitioners of evidence-based care. In this chapter, they learn

xviii PREFACE

how to identify clinical problems, recognize patient safety issues, compose clinical questions that provide a clear direction for study, conduct a search of the literature, appraise and synthesize

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