Running head: NURSING'S LEADERSHIP ROLE IN POPULATION BASED

Nursing's Leadership Role in Population Based Issues Jennifer Edson Ferris State University

NURSING'S LEADERSHIP ROLE IN POPULATION BASED Abstract Sexually transmitted disease (STD) rates have increased in Kent County, Michigan. The teenagers are impressionable, and in danger because STDs usually do not show any signs and

symptoms. There are two nursing roles that will oversee the increase in rates in Kent County. A direct nurse whom will over see the school and provide direct care with educating and addressing the outbreak of STDs with the age population between 15 and 19 within the school system. This nurse will work directly with the children. The other role, is the leader nurse, who will work for the Department of Community Health. The leader nurse conducts studies and collects data to further promote healthy lifestyles among many other duties. Together they will collect data and work in conjunction with one another and implement a plan of action. Both roles are equally as important, but carry on different aspects of the care.

NURSING'S LEADERSHIP ROLE IN POPULATION BASED Nursing's Leadership Role in Population Based Issues

Being a nurse includes many responsibilities and roles. One of the roles of being a nurse is becoming involved with the community and educating individuals, patients and the community. It is important to create healthy lifestyles for individuals and for the community as a whole. My group chose the topic of sexually transmitted diseases (STD) in teenagers. The concern is the increased amount of infected teenagers in Kent County, Michigan. The population specifically of concern is those between the ages of 15 through 19 year olds. The rising trends for STDs are an important health issues that the community should be concerned about, especially those in the medical profession. Many sexually transmittable diseases show no signs or symptoms. Many diseases go unnoticed and untreated. However, the diseases can wreck havoc on the reproductive systems and cause many other issues such as fetal and perinatal health problems, cancers and promotes easier transmission of HIV. The Centers for Disease Control and Prevention (CDC) states, there are approximately 19 million new STD infections each yearalmost half of them among young people ages 15-24. The cost of STDs to the U.S. health care system is estimated to be as much as $15.9 billion annually (CDC, 2013). In Kent County, Michigan, 2012, there were 6,568 clinical visits for testing and/or treatment for HIV or STDs. With that number, 4,604 HIV tests were given and 23 of those tests had a positive result. (Kent County, 2012). That is almost two new diagnosis of HIV per month in Kent County. A report for Kent County, 2001, states that there were 1788 cases of Chlamydia between 1995-1999 per 100,000 populations for the age population of 15-19. Where as Michigan as a whole had 1,173 cases per 100,000 for the same age group (Kent County Health Department, 2001). The rates for Gonorrhea for the age group of 15-19 were 1072 per 100,000 individuals between the ages of 15-19 in Kent County for the years of 1995-1999. In Michigan

NURSING'S LEADERSHIP ROLE IN POPULATION BASED as a whole for the same age group and same years were only 621 cases per 100,000 (Kent County Healthy Department, 2001). According to the Center of Disease Control (CDC), in 2011, for the age brackets of 15-24, there were between 1,000.1-3,000 cases of Chlamydia in Kent County per 100,000, 300.1-600 cases of Gonorrhea per 100,000, and less than 2.2 cases of Syphilis per 100,000 population (CDC, 2013). After consideration of these statistics, and the alarming rates of infections in Kent County, Michigan, I believe the most appropriate person for direct contact with STD prevention and care, within the age group of 15-19, would be a school nurse. The nurse that is most appropriate to oversee the education and treatment of health issues would be a leader nurse employed by the Michigan Department of Community Health. Direct Contact-School Nurse The National Association of School Nurses defines school nurses as: A specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, selfadvocacy, and learning (American Academy of Pediatrics, 2008, p. 1052).

Second to childrens homes, the school environment is the next most influential place for students to learn. School nurses perform a critical role within the school health program by

NURSING'S LEADERSHIP ROLE IN POPULATION BASED addressing the major health problems experienced by children. This role includes providing preventive and screening services, health education and assistance with decision making about

health, and immunization against preventable diseases (American Academy of Pediatrics, 2008, p. 1052). This role is especially necessary regarding sexual interactions and education. Especially with the rising amounts of new cases of sexually transmitted diseases being diagnosed. The school nurse gives direct care to the students. The school nurse provides care, educates, treats chronic health conditions, and communicates with the students family doctor and parents when applicable and appropriate. They create health plans for individual care and provide leadership for the health plan set forth for students. The school nurse provides screening for illnesses and can provide referrals for health conditions. For instance, if the school nurse suspects there are sexual issues with the students, they could refer the student to planned parenthood or to the Public Health Department for further help for anything above and beyond the school nurses scope of practice. Leadership Role The community of Kent County needs to come together and create a safe environment for students to turn to. The students of Kent County need support, treatment and education in regards to the repercussions that can result due to sexual activity. Most importantly, these teenagers have to have the education on prevention of STDs, and the knowledge of where to go to get tested and treated because the majority of sexually transmitted diseases show no signs or symptoms. STDs can result in sterility or harbor future problems with their health, such as cancer. The school nurse will provide screening and referrals for health issues and they will refer students for appropriate medical care and use appropriate community resources to achieve these goals.

NURSING'S LEADERSHIP ROLE IN POPULATION BASED This nurse would be responsible for educating students on safe sex. The school nurse

should have an open door policy and confidentiality should be most important. This can be done with individual teachings and can be accomplished through emails, newsletters and group discussions. They will also aid in developing curriculums for science, health education classes that include nutrition, exercise, and prevention of sexually transmitted diseases, and pregnancy prevention. The school nurse will continue with leadership skills when communicating with doctors and parents, when confidentiality allows (American Academy of Pediatrics, 2008). Leadership Characteristics The characteristics of a nurse in this role will have to be non-judgmental, trustworthy of personal information, compassionate and they need to be able to relate to the students. Direct and honest communication skills are very important. Because there are many children in each school, time management and organizational skills are a must as well. ANA Standards of Professional Practice The school nurse will assess and collect data and vital information that is related to the educational needs of the students in regards to the sexuality and prevention of disease. They will also use the supporting data to create a plan and to determine the needs for the individuals and identify desired outcomes. They then will implement the plan they have created. After implementation they will evaluate the outcomes and adjust where appropriate. The nurse will have to keep current with the latest statistics and the latest information in regards to the trends of sexually transmittable diseases and will have to educate to prevent and diagnose current and future problems (American Nurses Association, 2010). I believe the nurse in this position will have to have excellent communication skills in order to have open communication with the students. Since the school is the second most

NURSING'S LEADERSHIP ROLE IN POPULATION BASED influential place that kids learn, it is important that, students attending school should have the opportunity to receive knowledgeable and accessible sexual behavior education and counseling (Harkness & DeMarco, 2012, p. 441). Leader Nurse-Michigan Department of Community Health The Michigan Department of Health is what I chose to oversee the plan to educate and promote safe sex and testing. The Michigan Department of community Health offers a wide range of services to the community. The leader nurse will assess the types of communicable sexually transmittable diseases being spread, will assess laboratory data, and specific treatments available. Outcomes will be identified after a review of treatment, control measures, education and resource manuals, and will gather epidemiological data. An evaluation will be used to determine if the numbers of cases of STDs have declined. This department will oversee the direct care nursing of the public school systems as the taxpayers help financially support them both. The Michigan Department of Community Health abides by confidentiality and this

includes abiding by HIPPA laws. The clinic department can be utilized by the teenagers so they have a safe to get further information (beyond the school nurses scope of practice), be educated, examined, tested and treated. The Michigan Department of Health provides care regardless if the client can pay or not. The Michigan Department of Health provides education and statistics along with other vital information on their website. Leadership Roles This nurse has just as an important role as the direct nurse. This nurse will collaborate with other health departments, school systems and doctor offices and most importantly, would work in conjunction with the school nurse. The Department of Community Health will oversee the information; statistics, education and preventative care information that is being offered by

NURSING'S LEADERSHIP ROLE IN POPULATION BASED the school nurse. This position would require research on statistics, epidemiological trends and education in regards to sexual health. Leadership Skills

The skills that are required with a Department of Community Health nurse would require the skills of collaboration, communication and teamwork. This position will work heavily with the school system and will need to decipher data in a timely matter as to what is working with preventative care, and what is not working. This leader nurse will have to be extremely organized to keep the data current, statistics up to date, education and outcomes recent and organized. This nurse will need to implement care plans, analyze data and interpret results. ANA Standards of Professional Practice The American Nurses Association (ANA) has a set of standards for public health nursing. There are eight principles to adhere to. They include the following: analytic assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice, basic public health science skills, financial planning and management skills, and leadership and system thinking skills (Harkness & DeMarco, 2012, p. 9). These are vital skills that must be implored because all of those qualities need to be applied to a position such as a nurse at the Department of Community Health. These nurses are going to work with a wide variety of diversity in culture and in economics. The communication needs to be sharp because again, there will be a wide range of communication skills by the clients and community. These nurses have a lot of responsibility with having such a wide variety of clients and must acquire many skills.

NURSING'S LEADERSHIP ROLE IN POPULATION BASED Analysis The similarities between the two nurses will require excellent communication skills and

an ability to teach and educate. The direct contact nurse will apply the excellent communication skills to individuals, families, teachers, as well as other health professionals, such as the Department of Community Health system. The leader nurse needs their communication skills for program directors, other health professionals and administrative personnel. Both of these nurse roles will carry a non-judgmental and open-minded view. They will relate to the teenagers and create a trusting bond. These behaviors by the health care personnel will create a comfort zone where the teenagers can feel like they have someone to look up to, ask questions to and trust with their sexual health issues. In regards to education between the two different roles, I believe that a Bachelors Degree in Nursing for the direct care nurse would suffice. A Bachelors Degree will be more than adequate for educating and promoting safe sex and referring clients to the proper care facilities. However, with the lead nurse, a masters degree should be required. They have a wider job description; they deal with the government, other health care facilities. They have more responsibilities, such as case management, the research and statistics of health care needs and overseeing the direct care nurses of the school systems. The direct contact nurse is working directly with the teenagers (clients). This nurse has the direct impact on the individuals. They have the opportunity to help, respect, earn trust and can help during a school day. The leaders nurse responsibility is far more broad and does not contain as much direct care. They are behind the scenes creating education pamphlets, promoting safe sex (and abstinence), keeping current with statistics, epidemiological data, and trends, they research outbreaks, and analyze why. They also write proposals for grants, fund

NURSING'S LEADERSHIP ROLE IN POPULATION BASED programs and make sure there are clinics available to clients for testing, treatment and analyze outcomes. Reflection My nursing skills are mostly related to the direct care nursing roles. I believe I have acquired many great nursing skills such as: trusting, caring, understanding and being non-

10

judgmental. I believe I have the ability for people to open up and share information and patients tend to listen to their education and treatment plans. However, I also think I could be a great leader nurse as well. I feel I am great at leading and getting things accomplished, however, I do not think a position such as a nurse with Department of Community Health would benefit the patients or me. I do not find statistics and research very appealing. I would not work well with long projects such as trending statistics and writing grants. The part I would like about the Department of Community Health would be the advocating. Advocating for the patients and community for proper education, care, and treatment. Each nurse has their own set of skills they have or have acquired throughout their professional career. Some professionals find they lack empathy and put themselves in a research role, while others are made to be bedside nurses because they have so much compassion. While other nurses like to teach and find themselves in a school system teaching preventative health issues, safe sex, and healthy lifestyles. Other nurses like to keep to themselves and find themselves in the operating room. Some nurses cant keep still and thrive on the adrenaline from excitement; they typically end up as an emergency room nurse. Generally speaking, each type of these nurses described above have a personality that fits their nursing role.

NURSING'S LEADERSHIP ROLE IN POPULATION BASED The individual skills that nurses have should be utilized with patients in the best way to

11

enhance care. With the skills that are lacking, time should be spent trying to obtain them so they can be utilized when they need to be.

NURSING'S LEADERSHIP ROLE IN POPULATION BASED

12

References American Academy of Pediatrics (ANA). (2008, May). Role of the school nurse in providing school health services. Pediatrics, 121, 1052-1056. http://dx.doi.org/doi: 10.1542/peds.2008-0382 American Nurses Association, (2010). Nursing professional development: scope and standards of practice. Silver Springs, MD: Nursebooks.org Centers for Disease Control and Prevention (CDC), (2013). Rates of reportable STDs among young people 15-24 years of age Michigan, 2011. Accessed from http://www.cdc.gov/std/stats/by-age/15-24-all-STDs/state/2011/MI11.pdf Harkness, G.A. & DeMarco, R.F. (2012). Community and Public Health Nursing Practice: Evidence for Practice. Wolters Kluwer/Lippincott, Williams & Wilkins: Philadelphia Kent County Health Department, (2001). Communicable disease in Kent County. Retrieved from http://www.accesskent.com/Health/Publications/pdfs/h_cdrep3.pdf Kent County, Michigan, (2012). 2012 annual report. Retrieved from http://www.accesskent.com/Health/Publications/pdfs/2012_annual_report.pdf on February 19, 2014 U.S. Department of Health and Human Services, (2013). Healthy People 2020; sexually transmitted diseases. Retrieved from www.healthypeople.gov/2020/topicsobejectives2020/overview.aspx?topicid=37