Description
Social Determinants of Health Interview Assignment
The purpose of the Social Determinants of Health assignment is to provide you an opportunity to conduct an interview with a family member or friend to explore their social determinants of health. You will focus on are those influences that can affect a person’s health status, functioning, quality of life and risks. As you explore social determinants of health, consider upstream, population, and health care system factors that affect the health of an individual. For example, some factors to consider that influence an individual are what you are born with, your experiences, age, how you live, learn, work, play, and worship. By conducting an interview, you will get firsthand information about how social determinants of health affects your family member or friend.
Student Learning Outcomes:
2. Foster human flourishing through the delivery of holistic, ethical, developmentally appropriate, person-centered care that extends compassion to those in need.
3. Apply knowledge of health promotion strategies to promote the delivery of just and equitable care that reflects cultural humility, inclusivity, consideration of social determinants of health, and advocacy.
4. Utilize a spirit of inquiry that seeks to improve health outcomes using evidence-base care as the foundation of nursing practice.
Course Objective:
Apply concepts of population health to reduce health disparities and improve health outcomes of communities.
Utilize the principles of servant leadership, and the Catholic Health Ministry to promote culturally sensitive nursing care of vulnerable populationsInstructions
Review all the instructions below and the Blackboard rubric for the assignment.
Select and schedule an appointment with an individual that you would like to interview for thisproject. This individual can be a family member or friend.
3. Prepare for your interview by reading the Utilizing Fawcett’s model (Nursing Outlook article, 2015) and reviewing the course learnings on social determinants of health. The Fawcett’s article is a great resource to help you write your interview questions. See the direct link below to read the article by Fawcett & Ellenbecker (2015) which describes a conceptual model at the intersection of nursing and population health
Direct link: A Proposed Conceptual Model of Nursing and Population Health
4. The interview should focus on the following factors as outlined in the Fawcett’s article:
Upstream factors
Socioeconomic environment
ii. Physical environment
Population factors
Genetic factors
Behavioral factors
Physiological factors
Resilience
Health State
Health care system factors
Providers
Organizations and institutions
1. Department of health 2. Hospitals
Inpatient and outpatient clinics
Community health centers
Home health care agencies
Payers
Policies
Conduct the interview and take notes. Schedule a time immediately following the interview toreview your notes to ensure that your notes are complete.
Write a 2-4-page APA formatted paper that integrates knowledge of Fawcett’s model with theinformation from the interview and present it in a professional manner.
Your paper should cover the social determinants as outlined in the Fawcett’s article.
Write your paper from a professional viewpoint.
The paper should include the following: Cover page (no abstract)
Introduction
Body with Headers
Conclusion that reveals the synthesis of the information presented
Use of in-text citation Reference page which includes the citation of the FawcettModel
Be sure to read the APA requirements at the end of this instruction sheet.
Submit your paper in blackboard under the Assignment tab on the left-hand side of the course page.
APA Requirements:
This paper should be written in APA format.
First person is acceptable in this paper
Level 1 headers must be used to label the content sections
No abstract required
Use direct quotes sparingly, if at all.
The paper should include: title page with honor code, instructor name and date; no more than 2-4 pages ofcontent; reference page
Please take note of your Safe Assign report. Remember, you can submit a draft early to review your SafeAssign feedback before submitting a final draft.See Blackboard for grading rubric.
Unformatted Attachment Preview
Social Determinants of Health Interview Assignment
Purpose
The purpose of the Social Determinants of Health assignment is to provide you an opportunity to
conduct an interview with a family member or friend to explore their social determinants of health. You
will focus on are those influences that can affect a person’s health status, functioning, quality of life and
risks. As you explore social determinants of health, consider upstream, population, and health care
system factors that affect the health of an individual. For example, some factors to consider that
influence an individual are what you are born with, your experiences, age, how you live, learn, work,
play, and worship. By conducting an interview, you will get firsthand information about how social
determinants of health affects your family member or friend.
Student Learning Outcomes:
2. Foster human flourishing through the delivery of holistic, ethical, developmentally appropriate,
person-centered care that extends compassion to those in need.
3. Apply knowledge of health promotion strategies to promote the delivery of just and equitable care
that reflects cultural humility, inclusivity, consideration of social determinants of health, and advocacy.
4. Utilize a spirit of inquiry that seeks to improve health outcomes using evidence-base care as the
foundation of nursing practice.
Course Objective:
Apply concepts of population health to reduce health disparities and improve health outcomes
of communities.
Utilize the principles of servant leadership, and the Catholic Health Ministry to promote
culturally sensitive nursing care of vulnerable populations
Instructions
1. Review all the instructions below and the Blackboard rubric for the assignment.
2. Select and schedule an appointment with an individual that you would like to interview for this
project. This individual can be a family member or friend.
3. Prepare for your interview by reading the Utilizing Fawcett’s model (Nursing Outlook article,
2015) and reviewing the course learnings on social determinants of health. The Fawcett’s article
is a great resource to help you write your interview questions. See the direct link below to read
the article by Fawcett & Ellenbecker (2015) which describes a conceptual model at the intersection of
nursing and population health
Direct link: A Proposed Conceptual Model of Nursing and Population Health
4. The interview should focus on the following factors as outlined in the Fawcett’s article:
a. Upstream factors
i. Socioeconomic environment
ii. ii. Physical environment
b. Population factors
i. Genetic factors
ii. Behavioral factors
iii. Physiological factors
iv. Resilience
v. Health State
c. Health care system factors
i. Providers
ii. Organizations and institutions
1. Department of health
2. Hospitals
3. Inpatient and outpatient clinics
4. Community health centers
5. Home health care agencies
iii. Payers
iv. Policies
5. Conduct the interview and take notes. Schedule a time immediately following the interview to
review your notes to ensure that your notes are complete.
6. Write a 2-4-page APA formatted paper that integrates knowledge of Fawcett’s model with the
information from the interview and present it in a professional manner.
a. Your paper should cover the social determinants as outlined in the Fawcett’s article.
b. Write your paper from a professional viewpoint.
c. The paper should include the following:
Cover page (no abstract)
Introduction
Body with Headers
Conclusion that reveals the synthesis of the information presented
Use of in-text citation Reference page which includes the citation of the Fawcett
Model
d. Be sure to read the APA requirements at the end of this instruction sheet.
7. Submit your paper in blackboard under the Assignment tab on the left-hand side of the course
page.
APA Requirements:
This paper should be written in APA format.
First person is acceptable in this paper
Level 1 headers must be used to label the content sections
No abstract required
Use direct quotes sparingly, if at all.
The paper should include: title page with honor code, instructor name and date; no more than 2-4 pages of
content; reference page
Please take note of your Safe Assign report. Remember, you can submit a draft early to review your Safe
Assign feedback before submitting a final draft.
See Blackboard for grading rubric.
Available online at www.sciencedirect.com
Nurs Outlook 63 (2015) 288e298
www.nursingoutlook.org
A proposed conceptual model of nursing
and population health
Jacqueline Fawcett, PhD, RN, FAAN*, Carol Hall Ellenbecker, PhD, RN
Department of Nursing, University of Massachusetts Boston, Boston, MA
article info
abstract
Article history:
Received 29 August 2014
Revised 17 December 2014
Accepted 5 January 2015
Available online 19 February
2015
Objective: To describe a Conceptual Model of Nursing and Population Health about
Keywords:
Population health
Nursing
Conceptual model
the intersection of nursing and population health.
Methods: Review of literature and derivation of a new conceptual model.
Results: The conceptual model concepts are upstream factors, population factors,
health care system factors, nursing activities, and population health outcomes.
Nursing activities mediate the indirect relations of upstream, population, and
health care system factors with population health outcomes; in addition, health
care system factors and nursing activities are directly related to population
health outcomes. Implications for research methods, revisions in all levels of
nursing education, and population-focused advances in nursing practice are
identified.
Conclusion: The strength of the model is its emphasis on attainment of the highest
possible quality of life for populations, by means of nursing activities directed to
promote or restore and maintain wellness across the life course and to prevent
disease.
Cite this article: Fawcett, J., & Ellenbecker, C. H. (2015, JUNE). A proposed conceptual model of nursing
and population health. Nursing Outlook, 63(3), 288-298. http://dx.doi.org/10.1016/j.outlook.2015.01.009.
The increasing global recognition of many common
disease conditions requires population-level rather
than individual-level solutions. The purpose of this
article was to challenge nurses to shift their thinking
from individual health to the health of populations by
providing a comprehensive understanding of what
population health is; discussing the role nursing plays
in improving the health of populations; describing the
Conceptual Model of Nursing and Population Health
(CMNPH); and identifying implications for population
health research methods, nursing education, and
nursing practice. The conceptual model is based on
our understanding of the meaning and methods of
population health and is intended to advance contributions of the discipline of nursing to population
health.
Rationale for a CMNPH
Conceptual models are made up of a set of abstract
and general concepts and propositions that describe
the concepts and explain relations among concepts.
Their value lies in offering a systematic way of
understanding phenomena, guiding action, and
providing a framework for derivation of the relatively
specific and concrete concepts and propositions of
middle-range and situation-specific theories (Bigbee &
Issel, 2012; Fawcett & DeSanto-Madeya, 2013). The
particular value of a CMNPH is its guidance for nursing
research and nursing practice that comes from
an enhanced understanding of population health
phenomena.
* Corresponding author: Jacqueline Fawcett, Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125-3393.
E-mail address: jacqueline.fawcett@umb.edu (J. Fawcett).
0029-6554/$ – see front matter Ó 2015 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.outlook.2015.01.009
Nurs Outlook 63 (2015) 288e298
In recent years, many health care experts have
called for a shift in thinking about health care from an
emphasis on individual disease conditions to
population-level disease prevention and wellness
promotion. This paradigm shift is caused by the widely
recognized failure of the U.S. health care system,
which spends approximately 75% of its health care
resources on curing disease and expensive hospitalizations and very little on disease prevention (American
Public Health Association, 2012). Although the U.S.
spends more on health care than any other nation, the
outcomes are not as good as those of most highincome nations. A comparison of health indicators
from the U.S. with those from 16 other peer countries
revealed that Americans on average have shorter lives
and have higher rates of disease and injury than people
in other high-income countries (Institute of Medicine
[IOM], 2013). Specifically, people of all age groups and
socioeconomic levels residing in the U.S. fare worse
than people residing in other peer countries in rates of
infant mortality, infants of low birth weight for gestational age, injuries, homicides, adolescent pregnancy,
sexually transmitted infections including but not
limited to HIV and AIDS, drug-related deaths, obesity,
diabetes, heart disease, chronic lung disease, and disabilities. In 2013, the U.S. ranked 17th in life expectancy
at birth among 17 other high-income nations (IOM,
2013).
According to the IOM (2013), “the U.S. health disadvantage has multiple causes and involves some combination of inadequate health care, unhealthy
behaviors, adverse economic and social conditions,
and environmental factors, as well as public policies
and social values that shape those conditions” (p. 3).
Improving the health of the nation’s population by
addressing system failures and factors that lead to
these failures requires a shift in thinking from individually based disease care to population health care.
Nurses, who comprise the largest group of health care
providers in the U.S. health care system (American
Association of Colleges of Nursing, 2011), are partially
responsible for the poor health of the population
because of a traditionally narrow focus on individuals
and diseases. As Bekemeier (2008) pointed out, nurses’
participation in the current individual-centered health
care system is a tacit agreement to improve “the health
of the few” people they serve while at the same time
participate, albeit with the best intentions, in “the
illness and death of many” (p. 51). However, with a
history of population-focused community and public
health nursing practice (Buhler-Wilkerson, 1989; Dock
& Stewart, 1938; Radzyminski, 2007; Skretkowicz,
2010), nurses are in an ideal position to shift thinking
and participate in and lead teams of health care providers, policy makers, and the lay public committed to
a strong focus on population health. Furthermore,
although the basic idea of population health is part of
nursing’s history, attention to population heath is
especially important as health issues become more
obviously global.
289
The contemporary interest in the population level of
nursing care was the catalyst for the addition of a
population health track in the PhD nursing program at
the University of Massachusetts Boston. Since its
inception, faculty and students have been continuously challenged to better understand the meaning of
population health, to identify appropriate research
methods for the study of population health phenomena, and to differentiate population health nursing
research from clinical nursing research. The proposed
CMNPH is one way to begin to overcome these
challenges.
Population Health Defined
“Population health,” according to Radzyminski (2007),
“has been a framework for providing health care since
the time of Hippocrates” (p. 37). The term population
health entered the modern policy and health care vocabulary during the past 2 or 3 decades (Batchelor,
2012) with an increase in citations in the mid-1990s
(Tricco, Runnels, Sampson, & Bouchard, 2008).
Although population health is a widely used term
across many disciplines, there is considerable confusion about what the term actually means and how the
discipline of nursing uses the term. Young (1998)
pointed out that the literal meaning of population
health is the health of populations. Some other definitions of population health focus on what it is not and
how it is distinguished from epidemiology, public
health, and community health rather than what it is.
Other definitions are more specific to what population
health is. Other elements of definitions of what population health is found in the literature are populations
defined by geography or common characteristics, a
focus on health outcomes for entire groups rather than
individuals, and determinants of health.
Population Health Defined by Distinctions
Batchelor (2012) linked population health with the
evolution of epidemiology. He contended “that the
concept of population health and its use in helping
understand health and disease is simply part of the
natural evolution of the science of epidemiology”
(p. 12). Baisch (2009) also linked population health with
epidemiology, explaining that population health is
typically used within the context of epidemiology and
addresses “broad determinants of health for populations” (p. 2469). Kindig and Stoddart (2003) asserted
that the focus of epidemiology is not sufficiently broad
and does not account for the various interactions between determinants of health outcomes.
Stoto (2013) drew distinctions between public health
and population health by contrasting the involvement
of governmental agencies, as did Radzyminski (2007).
Stoto (2013) explained, “First, [population health] is less
directly tied to governmental health departments [than
290
Nurs Outlook 63 (2015) 288e298
public health]. Second, [population health] explicitly
includes the health care delivery system, which is
sometimes seen as separate from or even in opposition
to governmental public health” (p. 2). Radzyminski
(2007) noted that public health focuses on “the relationship between the state and the health and welfare
of its citizens” (p. 40). Issel and Bekemeier (2010) placed
public health nursing within the context of organizations and governmental agency departments. Kindig
and Stoddart (2003) maintained that at least some determinants of health outcomes, such as income, education, and medical care, are beyond the scope of the
authority and responsibility of public health.
Baisch (2009) pointed out that the attributes of
population health overlap with the attributes of community health. Radzyminski (2007) acknowledged
overlaps but commented that although community
health focuses within the boundaries of a relatively
broad view of the community, population health is
boundaryless other than the boundaries of a specific
aggregate of interest.
Perhaps a major distinction between population
health and public health and community health is the
focus of public health on the development and
implementation of governmental policies, whereas
community health focuses on specific communities at
the grass roots level and population health is a
broader focus on the population of a nation- or
worldwide population experiencing a particular health
condition, such as cardiovascular disease or
tuberculosis.
Population Health Defined by Geography or Common
Characteristics
Populations typically are geopolitical nations, communities, and other geographic regions. Populations
also may be groups of employees, ethnic groups, persons with disabilities, groups of persons with particular disease characteristics, prisoners, or other groups
(Adler, Bachrach, Daley, & Frisco, 2013; Kindig &
Stoddart, 2003; Mason, 2014). Members of health care
systems, especially, may think of populations as
groups of patients (Adler et al., 2013).
Population Heath Defined by Outcomes
Kindig and Stoddart (2003) defined population health
as outcomes. Stoto (2013) pointed out that the use of
the term outcomes emphasizes “the implicit goal of
improving health outcomes” (p. 2). Sen (2002) used the
term health achievements, which emphasizes comparisons of what populations are able to be and do to
determine equity in achievement and distribution of
health gains rather than outcomes.
Population Health Defined by Determinants
A hallmark of population health, according to Kindig
and Stoddart (2003), is the patterns of determinants
of health outcomes and the interactions between these
determinants. They identified several determinants,
including “medical care, public health interventions,
aspects of the social environment (income, education,
employment, social support, culture) and of the physical environment (urban design, clean air and water),
genetics, and individual behavior” (p. 381). Bekemeier
(2008) noted that many experts across disciplines
are calling for a focus on upstream conditions (i.e., a
root cause approach that emphasizes the causes of
disease and disability in a population). The upstream
approach includes understanding of socioeconomic
determinants of wellness and illness as well as barriers
to attaining high-level wellness and access to health
care services.
The Conceptual Model
Young (1998) maintained that population health,
especially in Canada and the United Kingdom, connotes a “conceptual framework for thinking about why
some populations are healthier than others as well as
policy development, research agenda, and resource
allocation” (p. 4). The CMNPH emphasizes the intersection of nursing and population health. The CMNPH
draws primarily from the Institute for Health Care
Improvement (IHI) Population Health Model (Stiefel &
Nolan, 2012; Stoto, 2013), which was based on earlier
work by Evans and Stoddart (1990). Although those
models emphasized medicine as the driving force for
population health outcomes, the CMNPH underscores
the centrality of nursing while viewing medicine and
other health care providers as important but not central in this model.
The primary focus of the CMNPH is attainment of
the highest possible quality of life for aggregates of
people by means of nursing activities directed to promote or restore and maintain wellness and to prevent
disease, thus making it relevant to both the improvement of population health and the practice of nursing.
For the purposes of the CMNPH, population health is
defined as life span wellness and disease experiences of
aggregate groups of people residing in local, state, national,
or international geographic regions or those populations with
common characteristics. Population health includes aspects
of public health, health care delivery systems, and determinants of wellness and illness, emphasizing promotion,
restoration, and maintenance of wellness and prevention of
disease.
Conceptual Model Concepts
The concepts of population health are “more than the
sum of individual parts of a cross-sectional perspective . [and inclusion of] a broader array of the [social]
determinants of health than is typical in either health
care or public health” (Stoto, 2013, p. 2-3). The CMNPH
concepts encompass four social determinants of
Nurs Outlook 63 (2015) 288e298
population health outcomesdupstream factors, population factors, health care system factors, and
nursing activitiesdas well as the concept of population health outcomes. Each of these concepts is
multidimensional.
The dimensions of upstream factors are socioeconomic factors and physical environment. The dimensions of population factors are genetic factors,
behavioral factors, physiologic factors, resilience, and
health state. The CMNPH views the dimensions of genetic factors, behavioral factors, physiologic factors,
resilience, and health state at the population level,
whereas the IHI model (Stiefel & Nolan, 2012; Stoto,
2013) and the Evans and Stoddart (1990) model view
these dimensions at the level of the individual, which
obviously loses the population-level focus.
The dimensions of health care system factors are
providers, organizations and institutions, payers, and
policies. The dimensions of nursing activities are
population-based nursing practice processes and
culturally appropriate wellness promotion, restoration,
maintenance, and disease prevention. The dimensions
of population health outcomes are population-level
wellness, population-level disease burden, populationlevel functional status, population-level life expectancy, population-level mortality, and population-level
quality of life.
Conceptual Model Propositions
The nonrelational propositions of the CMNPH, which
are the definitions for each concept and its dimensions,
are provided in Table 1.
The relational propositions of the CMNPH, which
link the concepts, are as follows and are illustrated in
Figure 1:
1. Upstream factors, population health factors, and
health care system factors are interrelated.
2. Upstream factors, population factors, and health
care system factors are related to nursing activities.
3. Health care system factors are related to population health outcomes.
4. Nursing activities mediate the relations of upstream factors, population factors, and health care
system factors to population health outcomes.
5. Nursing activities are related to population health
outcomes.
Discussion
Limitations of the CMNPH
The CMNPH, like all conceptual models, is made up of
abstract and general concepts and propositions that
are too abstract and general to be directly tested.
Instead, a conceptual model is a guide or basis for
generating new theories and testing existing theories
291
by means of empirical research (Bigbee & Issel, 2012;
Fawcett & DeSanto-Madeya, 2013). Furthermore, the
development of the CMNPH is based on literature primarily from the U.S. and Canada. The extent to which
the model is relevant for use in other countries remains to be determined.
Implications for Nursing Research
The primary purpose of nursing research is to expand
knowledge through generation and testing of theories
that provide the evidence for effective nursing activities including assessments and interventions as well
as measurement of outcomes (Fawcett & Garity, 2009).
The purpose of CMNPH-guided nursing research is to
advance knowledge of population health phenomena
by linking concepts and propositions of the model with
more specific and concrete concepts (research variables) and propositions (hypotheses) of descriptive,
explanatory, and predictive theories (Bigbee & Issel,
2012; Fawcett & Garity, 2009).
The trajectory of population-based nursing
research begins with baseline descriptions of theory
concepts representing upstream factors, population
factors, health care system factors, and current population health outcomes. (See Table 1 for nonrelational propositions of these CMNPH concepts and
their dimensions.) The research can be conducted
with various qualitative, quantitative, and mixed
methods research designs (Stoto, 2013). Concept
analysis techniques can be used to articulate a more
comprehensive definition of each concept of the
CMNPH (Table 1). Qualitative descriptive research designs can be used to enhance understanding of the
meaning of each concept to a particular population.
Quantitative descriptive research designs, including
instrument development studies and status surveys,
can be used to develop or refine instruments to measure theory concepts representing each CMNPH
concept and its dimensions. Realist reviews of literature, which focus on the feasibility of implementing
specific nursing activities in real-life settings, also are
needed (Pawson, Greenhalgh, Harvey, & Walshe,
2005).
Research progresses to the examination of relations
among theory concepts that are linked with upstream
factors, population factors, and health care system
factors (CMNPH relational proposition 1) and the root
causes of population health outcomes (CMNPH relational propositions 2, 3, 4, and 5) using correlational
and mixed methods designs that may be conducted by
means of secondary analyses of large data sets
(Patterson, 2014; Zeni & Kogan, 2007) using structural
equation modeling statistics. Correlational designs
using regression methods, such as path analysis, can
be used to test the mediating role of specific nursing
activities (CMNPH relational proposition 4; Kenny,
2012). Research then progresses to tests of the effectiveness of theory concepts linked with health care
system factors and specific nursing activities (CMNPH
292
Nurs Outlook 63 (2015) 288e298
Table 1 e Concepts of the Conceptual Model of Nursing and Population Health and Their Definitions
Concepts and
Concept Dimensions
Upstream factors
Socioeconomic environment
Physical environment
Population factors
Genetic factors
Behavioral factors
Physiological factors
Resilience
Health state
Health care system factors
Providers
Organizations and institutions
Departments of public health
Hospitals
Inpatient and outpatient clinics
Community health centers
Home health care agencies
Payers
Policies
Nursing activities
Definitions
Social determinants of health encompassing socioeconomic environment
and physical environment, which directly influence nursing activities and
indirectly influence population health outcomes
The circumstances of a population, including income, education,
employment, social support, and culture (Kindig & Stoddart, 2003)
The surroundings of the population, including the atmosphere of the earth,
gaseous composition of air, solid and gaseous pollutants, smoke, weather
conditions, geologic stability of the earth’s crust, water, urban and rural
design and resources, housing, ultraviolet radiation, bacteria, viruses, and
the built environment (Kindig & Stoddart, 2003; Orem, 2001; Stoto, 2013)
Determinants of health encompassing population-based genetic factors,
behavioral factors, physiological factors, resilience, and health state, all of
which directly influence nursing activities and indirectly influence
population health outcomes
Inherited characteristics of a population
Lifestyle variables of a population, such as smoking, alcohol consumption,
substance abuse, sexual behaviors, physical activity, and diet (Stiefel &
Nolan, 2012)
Biological variables of a population, such as vital signs, body mass index, and
cholesterol and blood glucose levels (Stiefel & Nolan, 2012)
A population’s “ability to bounce back or recover from adversity” (Garcia-Dia,
DiNapoli, Garcia-Ona, Jakubowski, & O’Flaherty, 2013, p. 267)
“A state of the [population] that is characterized by soundness or wholeness
of developed human structures and of bodily and mental functioning”
(Orem, 2001, p. 186)
Determinants of health encompassing providers, organizations, institutions,
payers, and policies that directly influence nursing activities and
population health outcomes and indirectly influence population health
outcomes
Nurses, physicians, therapists, pharmacists, technicians, and others who
provide health-related services to populations
Nurses may provide direct nursing care for populations, teach students and
other nurses, and/or conduct and report results of studies of phenomena of
interest to the discipline of nursing and population health
Relevant health care system organizations and institutions include
departments of public health, hospitals, inpatient and outpatient clinics,
community health centers, and home health care agencies
Local, state, or federally funded government entities responsible for the
public’s health
Institutions, large and small, that provide nursing and medical care that serve
populations experiencing acute disease conditions
Institutions that provide health-related services to populations who need
adjuvant therapy for acute and chronic illness and populations recovering
from acute disease conditions
Centers that provide nursing and medical care to community-based
populations
Agencies that provide home-based health care for populations of patients
Health insurance companies and other sources of reimbursement for healthrelated services
Policies include those addressing access to and use of health care by
populations
Policies about access address availability and compatibility of health care
for an entire population (Norris & Aiken, 2006)
Policies about utilization address actual use of health care by an entire
population
Actions performed by nurses directed to populations within the context of
multidisciplinary collaboration and coordination that directly influence
population health outcomes and that mediate the relations of upstream
factors, population factors, and health care system factors to population
health outcomes
(continued on next page)
Nurs Outlook 63 (2015) 288e298
293
Table 1 e (Continued )
Concepts and
Concept Dimensions
Population-based nursing practice
processes
Culturally appropriate wellness
promotion, restoration, and
maintenance
Culturally appropriate disease prevention
Population health outcomes
Population-level wellness
Population-level disease burden
Population-level functional status
Population-level life expectancy
Population-level mortality
Population-level quality of life
Definitions
Provision of population-based nursing practice processes as formalized in the
practice methodologies of various nursing conceptual models and theories
(Fawcett & DeSanto-Madeya, 2013) directed to actions that create
environments for populations that promote, restore, and maintain
wellness, and prevent disease. Nursing practice processes include all
phases of the nursing process (assessment, planning, intervention,
evaluation) with special emphasis on data collection, tracking, and
analysis, and health care team coordination and collaboration
Provision of nursing practice processes directed to enhancing the optimal
level of the population’s collective “growth, integration of experience, and
meaningful connection with others, reflecting [population] valued goals
and strengths, and resulting in being well and living values” (p. 48) within
the context of the culture of the population (McMahon & Fleury, 2012)
Provision of nursing practice processes directed to preventing the occurrence
of objective and tangible clinical signs and symptoms of a health problem
(Venes, 2013)
The status of the health of a population encompassing population-level
wellness, disease burden, functional status, life expectancy, mortality, and
quality of life, resulting directly from health care system factors and
provision of nursing activities and indirectly from upstream, population,
and health care system factors mediated by nursing activities
The population’s collective level of “growth, integration of experience, and
meaningful connection with others, reflecting [population] valued goals
and strengths, and resulting in being well and living values” (McMahon &
Fleury, 2012, p. 48)
Incidence and/or prevalence of major chronic health conditions in a
population (Stiefel & Nolan, 2012); “the total effect of a disease” (p. 699) on a
population (Venes, 2013)
A population’s optimal level of performing usual activities of daily living
A population’s overall “expected years of remaining life at any age” (Stiefel &
Nolan, 2012, p. 13)
“Years of potential life lost” (p. 4) for a population (Stiefel & Nolan, 2012)
A population’s “physical, psychological, social, economic, and
environmental” (p. E5) well-being (Fulton, Miller, & Otte, 2012)
relational propositions 3 and 5) by means of natural
experiments and quasi-experimental and true experimental designs, with randomization at the level of the
population. Cost-benefit and cost-effective analyses of
specific nursing activities and specific policies linked
with the policy dimension of health care system factors also are important topics for CMNPH-guided
nursing research.
Inasmuch as the policies dimension of health care
system factors addresses access to and use of health
care by populations, the availability and compatibility
of health care for an entire population, and the actual
use of health care by an entire population, the CMNPH
is an excellent guide for studying health disparities and
social justice. For example, studies could be designed
to examine the extent to which a population experiences disparities in health outcomes because of limited
access to and use of available health care, taking into
account the socioeconomic environment dimension of
upstream factors. Other studies could focus on social
justice using correlational research designs to examine
the relations of pollution or toxic waste dumping in the
physical environment (a dimension of upstream factors) to the dimensions of population factors (genetic,
behavioral, and physiological factors; resilience; and
health state).
A crucial area of population-based nursing research
is the analysis and evaluation of health policies, which
