The alarming opioid crisis, with its staggering death rates, is affecting the life expectancy rates of Americans. Select one of the populations on the map and address the following: (New York)
- Compare the opioid-related overdose death rates of the selected population to national opioid-related overdose death rates.
- Identify one primary, one secondary, and one tertiary prevention intervention to reduce the misuse of opioids in the selected population.
- Describe one evidence-based strategy to address provider opioid prescription rates.
- Identify the stakeholders charged with addressing the opioid crisis in your community.
- Share your professional experience related to the topic.
- Please read the question carefully to answer all the components. Identifying primary, secondary, and tertiary interventions can be a little confusing. Remember that primary interventions are about prevention, secondary interventions are about screening and tertiary interventions are about treatment. Our interactive discussion addresses the following course outcome:
- CO5: Evaluate the impact of the global burden of diseases on population health. (PO 1)
Reflection on Learning
Reflective inquiry allows for expansion in self-awareness, identification of knowledge gaps, and assessment of learning goals. Each week, you will reflect upon what you have learned and complete a reflective journal assignment: Reflection on Learning. Each weekly reflection is placed in one document, which will be submitted for grading at the end of Week 7. There is no weekly reflection in Week 8 because a reflection is incorporated into the discussion question. Please review the Reflection Guidelines and Rubric for complete assignment requirements. Create a document where you will keep your weekly reflection.
In your document, write 2 paragraphs reflecting on your experience of beginning your journey to achieve your DNP and becoming a practice scholar
- As you assess your learning, provide one specific example of how you achieved the weekly objective(s):
- Which population health interventions did you find the most valuable and why?
- What do you value most about your learning this week?
respond to each in a paragraph directly below each question. Each question in each section could then be explained in a MEAL Plan paragraph.
Welcome to Week 4—the midpoint of your journey in NR704! The week kicks off with an investigation into the levels of prevention. You may already be familiar with these three levels. Our exploration brings a fresh perspective to these concepts by considering how they relate to improving outcomes for all populations. You’ll meet Kevin and follow his story to view these levels of prevention in action. Dr. Patrick LaRose, our industry expert in population health, will guide your examination of population health program interventions and stakeholders. Like other aspects of population health, the number of stakeholders is expanded to include the population and community impacted, among others. This week, you’ll once again use the population health map to address the week’s concepts as they relate to a selected population. This gives you hands-on experience with these important concepts. Ready? It’s time to get started!
Week 4: Student Lesson Plan for Learning Success
Outcomes, Objectives, and Concepts
| Weekly Outcomes | Weekly Objectives | Main Topics and Concepts |
| Evaluate the impact of the global burden of diseases on population health. (PO 1) | Formulate population health interventions to address the global burden of disease.Define the role of the practice scholar in addressing the global burden of disease and the impact on population health.Differentiate interventions to promote prevention of population health issues. | Wellness Promotion and Illness PreventionPrimary PreventionSecondary PreventionTertiary PreventionInterventions in Population HealthMinnesota Intervention WheelAccess to Population Health ServicesPopulation Health ProgramsImpact of Stakeholders |
Foundations for Learning
Start your learning this week by reviewing the Health People 2020 goals.
Since 1979, the U.S. Department of Health and Human Services (HHS) has analyzed data from past decades, integrated new knowledge, current data, trends, and research to determine the nation’s healthcare priorities for the next 10 years. Our nation’s health priorities are associated with many areas such as national health, national preparedness, and disease prevention, as well as identification of risks to health and wellness and changing public health priorities. Planning is underway for the development of Healthy People 2030. For additional information, go to http://www.healthypeople.govLinks to an external site.
Student Learning Activities
| Learning Activities | This week you will complete: PrepareAssigned ReadingsExplore Interactive LessonTranslate to PracticeDiscussion Question ReflectReflection on Learning |
| Additional Resources | Centers for Disease Control and Prevention. (n.d.). Picture of America: Prevention. https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf (Links to an external site.) Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annual review of public health, 36, 559-574. |
Learning Success Strategies
- Review assigned readings to ensure you understand how to apply levels of prevention to promote health and wellness.
- As you review weekly content, consider how each concept and discussion can be translated into practice at your unique setting.
- Be ready to share your thoughts through the interactive discussion. Review the discussion guidelines and rubric to optimize your performance.
- You have access to a variety of resources to support your success. Click resources on the home page to access program and project resources.
- Remember, faculty are here to support you. Please email, text, or call with questions. Review rubric feedback and individual comments to optimize performance.
- Colditz, G. A., Philpott, S. E., & Hankinson, S. E. (2016). The Impact of the nurses’ health study on population health: Prevention, translation, and control. American Journal of Public Health, 106(9), 1540-1545. https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=117367929&site=eds-live&scope=site (Links to an external site.)
- Petersen, R., Rushing, J., Nelson, S., & Rhyne, S. (2016). Improving population health by incorporating chronic disease and injury prevention into value-based care models. North Carolina Medical Journal, 77(4), 257-260. https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=27422946&site=eds-live&scope=site
Week 4: Prevention and Interventions in Population Health
Wellness Promotion and Illness Prevention
The DNP scholar utilizes evidence-based models and practices to improve health outcomes. In population health, the shift in national priorities from illness management to wellness and illness prevention has placed primacy on prevention-focused interventions for outcome improvement. Prevention methods are often categorized as primary, secondary, and tertiary levels of prevention, according to the objective of the intervention (CDC, n.d); all levels of prevention management aim to improve outcomes across populations.
View the image below to examine the levels of prevention.
Primary = Prevention
Secondary = Screening
Tertiary = Treatment
Primary prevention targets disease or disability prevention. These interventions focus on health promotion and address a universal population. Primary prevention interventions occur across settings, including healthcare organizations, school-based health clinics, complementary and alternative medicine (CAM) clinics, social media, as well as private homes (American Academy of Pediatrics, 2018). One example of a primary prevention intervention is a program to promote breastfeeding to reduce the occurrence of childhood obesity and comorbidities. Another example is vaccination programs to reduce the occurrence of infectious diseases.
View the following activity to explore primary prevention in action.
[MUSIC] Meet Kevin. Let’s follow his story to observe the three levels of prevention in action. We’ll also explore the types of population health interventions available. Primary prevention is the first level of prevention. This level of prevention focuses on the prevention of a condition, disease, or diagnosis. Let’s consider how the level of primary prevention relates to Kevin.
Kevin is a 50-year-old male. He has increased the fiber in his diet to decrease his chances of colon cancer. Diet education is one population health intervention that is commonly seen as a primary prevention method.
Now reflect upon these primary prevention interventions.
The Hispanic population has seen a 34.6% rise in childhood obesity (Skinner, Ravanbakht, Skelton, Perrin, & Armstrong, 2018). What primary prevention intervention would help this population in lowering childhood obesity rates?
Many healthcare workers refuse to be immunized for influenza (Jessop, Scrutton, & Jinks, 2017). What primary prevention intervention is needed to increase the number of healthcare professionals receiving the influenza vaccination?
Secondary Prevention
Secondary prevention focuses on identifying already occurring health problems or conditions prior to the onset of serious or long-term problems. These interventions address selected or targeted symptomatic populations. The objective of secondary prevention is early diagnosis and initial treatment or stabilization of disease in the early stages before it causes significant morbidity and mortality. These interventions can occur in all the some venues as primary interventions, as well as in emergency departments and retail-based clinics, such as Walgreen’s (Moreland & Curran, 2018).
View the following activity to discover secondary prevention in action.
[MUSIC] The second level of prevention is Secondary Prevention. Secondary prevention is the process of screening for any potential condition, disease, or diagnosis. Let’s return to Kevin to see how this level of prevention relates to him. Kevin is in pre op waiting for his colonoscopy. He’s having this procedure done to screen for colon cancer.
A colonoscopy is one example of an intervention use in secondary prevention.
Now reflect upon these secondary prevention interventions.
The health of a child is often dependent on the parents’ ability to provide access to healthcare. Taking time off of work, transportation issues, and other barriers may prevent parents from obtaining an early diagnosis of their child’s illness. One secondary prevention intervention is school-based clinics. These clinics, which are located primarily within high schools, can be staffed by advanced practice nurses, dentists, mental health professionals, and health educators. The availability of clinics allow for students to return to school earlier while improving health outcomes (Bemker & Ralyea, 2018). What other secondary prevention intervention would benefit this population?
Mental health care for the population of individuals who are serving or have served in the military is a rising priority (Stein, Kessler, & Ursano, 2019). One area of need is the use of secondary prevention methods to assess the potential for self-harm or suicide. What secondary prevention may help to reduce the suicide rate in the military population?
Tertiary Prevention
Tertiary prevention aims to slow or stop the progression of disease. These interventions target individuals who are already diagnosed with a disease condition and work to restore function and reduce disease-related complications (Moreland & Curran, 2018).
View the following activity to investigate tertiary prevention in action.
[MUSIC] The third level of prevention is tertiary prevention, which is the act of managing a disease after diagnosis. Let’s return to Kevin to see how this level of prevention relates to him. During Kevin’s colonoscopy, the provider discovered polyps. The polyps were removed. And the pathology report reveals cancer. Tertiary prevention is the process of intervention and treatment.
It involves managing the disease post-diagnosis to slow or stop disease progression. Kevin’s story illustrates an example of primary, secondary and tertiary prevention, including interventions for each level of prevention.
Now reflect upon these tertiary prevention interventions.
Latest evidence suggests that therapeutic intervention strategies for Alzheimer’s disease must be reconsidered as pathogenesis is now known to vary at different stages of the disease.(Bu, Jiao, Lian, & Wang, 2016). What tertiary prevention intervention is helpful for the effective prevention and treatment of Alzheimer’s disease?
Preterm birth is a leading contributor of perinatal morbidity and mortality (Matei, Saccone, Vogel, & Armson, 2019). What tertiary prevention intervention is needed to help reduce the occurrence of preterm birth?
Population Health Interventions
Population health interventions typically address one of the three levels of prevention and target the population as a whole. For example, an intervention may encompass individuals who are at risk for breast cancer, influenza, or impacted by a tornado. These interventions are not free. Funding plays a significant role in the creation and management of population health interventions, and health policy informs the type of interventions as well as the resource allocation. (Links to an external site.)
View the following video about population health interventions by industry expert and award-winning textbook author, Patrick LaRose, DNP, MSN/Ed, RN.
[MUSIC] All right, so by now you’ve already read through several of the chapters. And also have read through a lot of the wonderful content in the course regarding prevention. And prevention really is a big issue in relationship to population health. When we look at prevention we’re looking at the three levels.
We’re looking at primary, secondary, and tertiary. But the primary focus really is how the three prevention levels are gonna help us to define the interventions. Remembering, of course, that primary prevention is getting the disease before it gets to you or gets your population. So that’s gonna be interventions that are really focused on preventative strategies.
And of course, the secondary part of prevention is interventions that work to help mitigate if the disease is already in process before it becomes full blown. So those interventions would really be involved in mitigating the disease process itself, reducing the risk factors, and hopefully moving that patient or that population out of harm’s way.
And then of course, tertiary prevention is really referring to how do we reduce the symptoms. The patients or the population already has the disease in a pretty progressive way. And so what we need to do then is to propose inventions that really help to move the population into either a reduction of symptoms or into some more health seeking behaviors.
So when we really look at all of the elements of population health, that would include families, individuals, I always say aggregates. It really is focused on the population as a whole and then it vets down to what exactly within the population we’re talking about. So if you have a global population then you would move to the population in the United States, or then you would move to the population within your community, or then you may move to the population within your organization.
It really just depends on what focus your practice is in as to how you apply concepts of population health. So let’s talk a little bit more about intervention, and how intervention really can relate to mitigating what’s going on with some of the burdens of disease within our population. So I often like to think about education strategies that are used as a part of intervention.
The Minnesota Model Intervention Wheel
The Minnesota Department of Health developed a framework to underpin the most common interventions in population health. This framework, called the “intervention model” or “wheel,” defines the type of population-based intervention as well as the level of practice, including systems, community, the individual, and/or family. Essentially, the intervention framework provides a systematic approach to practice. Despite its age, this population health intervention planning tool is still widely utilized by health practitioners today.
View the image below to examine how each intervention component aligns across the levels of practice.
Click on the image to enlarge.
Public Health Nursing Section: Public Health Interventions-Applications for Public Health Nursing Practice. St. Paul: Minnesota Dept. of Health, 2001.
The Minnesota Model Intervention Wheel
Public Health Intervention
- Surveillance – Monitoring of health events through systematic health data collection and analysis.
- Disease investigation – Gathering and analysis of data pertinent to health issues of concern.
- Outreach – Locating vulnerable populations.
- Screening – Identifying individuals with unrecognized health risk factors.
- Case-finding – Locating individuals with risk factors to connects them with resources.
- Referral and follow- up – Assisting those in need of care and resources.
- Case management – Optimizing self-care and provision of services.
- Delegated functions – Directing care tasks a registered professional nurse carries out under the authority of a health care practitioner as allowed by law.
- Health teaching – Communicating health-related information.
- Counseling – Establishing an interpersonal relationship with professional services to enhance self-care and coping.
- Consultation – Seeking information and solutions to problems or issues through interactive problem solving.
- Collaboration – Commiting two or more persons or organizations to achieve a common goal.
- Coalition building – Promoting alliances among organizations for a common purpose.
Population Health Programs
Population Health Programs
Population health programs are created as interventions to address a population health concern. Health policy also drives health programs. Consider the Women, Infants, and Children (WIC) program. This program was created to provide supplemental nutrition for childbearing women, breastfeeding mothers, and infants and children up to age five. WIC has specific qualification guidelines to ensure those at greatest risk receive the nutritional support.
View the following video about population health programs by industry expert and award-winning textbook author, Patrick LaRose, DNP, MSN/Ed, RN.
[MUSIC] All right, we’ve learned about primary prevention, secondary prevention, tertiary prevention and we’ve also learned about intervention. So let’s tie this all together let’s really take a look at this whole module and this whole unit and bring it together by really talking about some incredible programs that really were driven from population health need.
First of all, how do we assess a need? That really has to be the issue, right, centerpiece of the nursing process is nursing assessment. So really we need to assess the need and oftentimes we can assess that need because we see these patients coming into our clinics, we see them coming into our hospitals, we see them in our nursing homes, we see them in all elements of our clinical situation.
And really we have the ability to identify what our aggregate issues are with these populations. We’ve talked a lot about type two diabetes, we’ve talked a lot about obesity, we’ve talked about heart disease, we’ve talked about hypertension and sadly we’ve talked about the staggering opioid crisis that’s currently happening within our country.
So if we really wanna take that as an example of an initial assessment of the opioid crisis in our country and say, what can we do about this? Well certainly, the one thing that really needs to be done is open access to care, so there needs to be some social justice here in the removal of inequalities.
Allowing people who are suffering from this devastating and debilitating addiction to get care and services. The addiction is bigger than they are, and they need that help and our ability to help them access that care as nurses is really a huge part of what we do in population health.
That means standing birth at the grass roots level, that means advocating for legislation to remove inequalities, to increase access to care, and to help maybe have some additional federal funding to address this staggering crisis within our country. And those are really the ways in which nurses can impact population health, the identification and the assessment of a problem, the engagement of goals.
And then the implementation of interventions that are really focused, sometimes laser focused on addressing those issues. It’s so nice to work within a country that has the organizational support that we have with the National Institutes of Health, with the Department of Health and Human Services, and with so many different organizations.
Delivering research, evidence based, primary information so that we can help patients within our populations improve their care status. I’m reminded of the program called, Women, Infant and Children and how that program really started and I think that’s a big important lesson for us. When we look at women, infant, and children, and that program was started to help women who were pregnant to have proper nutrition through their pregnancy and then to offer that nutrition to the infant after birth.
That was arrived at by a population health identified need and a legislative action that provided funding for women who were at risk and at need. These are the types of actions that we need to talk about, as we complete a population health course, and as nurses where we want to apply those concepts today.
So as you leave this module, I hope you found it incredibly informative, and maybe, if not anything else, I hope you take some of the strategies that you’ve learned. And you’re applying them today in your practice so that you can help change the direction and the trajectory of population health within your community, within your organization and within your own practice.
Thank you.
Impact of Stakeholders
As with any intervention, stakeholders must be considered. For population health programs and interventions, the stakeholder group is large. If you are providing care to an individual patient, you may only consider the needs of the patient, family, and healthcare team. In population health, stakeholders may include the city, state, and national governments, along with the population and community impacted. In population health programs and interventions the goal is achieve the “greatest good for the greatest number” (Bentham, 1996). The focus of population health is broad and the needs of all stakeholders must be considered.
Hello! Week 4’s concepts certainly offered some great information! Let’s take time to go over everything you learned this week. This part of your journey focused on analyzing levels of prevention. You’ve probably realized that as you explored these concepts, you’re already familiar with them. Now you understand them as they relate to improving outcomes for populations. You also investigated population health program interventions and used the population health map to apply the week’s concepts as they relate to a selected population. And with that understanding under your belt, you’re ready to move forward to Week 5!
References
References
Bentham, J. (1996). The collected works of Jeremy Bentham: An introduction to the principles of morals and legislation. Clarendon Press.
Bu, X. L., Jiao, S. S., Lian, Y., & Wang, Y. J. (2016). Perspectives on the tertiary prevention strategy for Alzheimer’s disease. Current Alzheimer Research, 13(3), 307-316.
Frieden, T. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590-596. https://doi.org/10.2105/AJPH.2009.185652
Jessop, C., Scrutton, J., & Jinks, A. (2017). Improving influenza vaccination uptake among frontline healthcare workers. Journal of infection prevention, 18(5), 248-251.
Minnesota Department of Health. (2001). Public health interventions: Applications for public health nursing practice. https://www.health.state.mn.us/communities/practice/research/phncouncil/wheel.html#citation
Matei, A., Saccone, G., Vogel, J. P., & Armson, A. B. (2019). Primary and secondary prevention of preterm birth. RHR/WHO review of systematic reviews and ongoing randomized controlled trials. European Journal of Obstetrics & Gynecology and Reproductive Biology.
Moreland, S. & Curran, J. (2018). A guide for monitoring and evaluating population-health-environment programs (2nd ed.). https://www.measureevaluation.org/resources/publications/ms-18-131
Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics, 141(3), e20173459.
Stein, M. B., Kessler, R. C., & Ursano, R. J. (2019). Reframing the suicide prevention message for military personnel. JAMA psychiatry.
