Borrowed Theory Public Health Intervention Wheel Shannon Haskett

Borrowed Theory: Public Health Intervention Wheel Shannon Haskett RN, BSN Jacksonville State University NU 540

Introduction The Public Health Intervention Wheel, also known as the “Intervention Wheel”, describes the scope of practice of public health nurses The wheel describes the work of public health nurses at the community and system level The wheel is non-nursing theory, meaning it is used by other public health disciplines (Wisconsin Department of Health Services, 2015)

History of the Wheel The wheel was carried out by public health nurse consultants at the Minnesota Department of Health in the mid 1990 s The wheel was first published in 1998 (Stanhope & Lancaster, 2012)

Levels of Public Health Practice Community Systems Individual/Family

Public Health Intervention Wheel

Public Health Interventions Surveillance Disease and Health Event Investigation Outreach Screening Case-Finding Referral and Follow-Up Case Management Delegated Functions

Public Health Interventions Health Teaching Counseling Consultation Collaboration Coalition Building Community Organizing Advocacy Social Marketing Policy Development and Enforcement

Pink Wedges Surveillance, health even investigation, outreach, and screening Surveillance is paired with a disease and health event investigation Screening follows surveillance or disease and health event investigation Screening is proceeded by outreach activities Screening may lead to case-finding (Minnesota Department of Health)

Green Wedge Referral and follow-up, case management, and delegated functions These interventions are implemented together in practice

Blue Wedge Health teaching, counseling, and consultation Teaching and counseling are paired the most when using in practice

Orange Wedge Collaboration, coalition building, and community organizing Grouped together because they are all types of collective action All done on the community or system level

Yellow Wedge Advocacy, social marketing, and policy development and enforcement Advocacy is viewed as a precursor to policy development Social marketing is a method of carrying out advocacy

Clinical Scenario Population of Interest: Elderly/ Geriatric Management of chronic diseases: maintaining health with congestive heart failure Scenario: Elderly patients who have congestive heart failure able to maintain their fluid balance, comply with medication regimen, know how to weigh themselves daily, and know when they need to call their physician.

Concepts Chosen to Go With Theory Advocacy Chronicity Collaboration

Goals of the Plan of Action Elderly patients at risk for having CHF will be able to overall lower their risk by increasing their heart function Elderly patients who have CHF will be able to decrease their BNP by taking their medication and reducing their fluid intake Elderly patients will be able to weigh theirselves daily and keep a log of their weight gain/loss with guidance of an APN Elderly patients at risk for getting CHF or who are diagnosed with CHF will be able to identify when to call the APN or physician when their symptoms increase Elderly patients at risk for getting CHF or who are diagnosed with CHF will have a better understanding of their condition and will comply with their medication regimen

Plan of Action Surveillance Finding health data from hospitalized newly congestive heart failure patients The data may come from hospital records, diagnostic reports, and outpatient records Collecting data by surveying the patients and following up with the patients on year after their diagnosis Surveillance consisted of data on incidence, prevalence, treatment, use of resources, and patient outcomes (National Heart, Lung, and Blood Institute, 2016) Disease and Health Event Investigation Analyzing data regarding advancing age being a major threat to elderly patients at risk for CHF “Rising epidemic of heart failure” is the result of people living longer and there being more effective treatments for coronary artery disease Average life expectancy is about 3 years after diagnosis Poor life quality, frequent hospital admissions, and poor survival (BMJ Publishing Group, 2010)

Plan of Action Outreach Visiting senior citizen facilities, assisted living facilities, churches, and other community centers Providing free education about congestive heart failure Screening Checking blood pressure Checking height and weight Having labs drawn (cholesterol, HA 1 C, BMP, BNP, CBC, thyroid) Having a physician consultation Radiology tests (echocardiogram, chest x-ray, CT of chest, heart catheterization)

Plan of Action Case Finding After screening and outreach is performed, those patients found at risk for CHF will be identified Those of that population will be located and reached to inform them of their condition or their risks for getting CHF Those patients will be connected with resources and a cardiologist to manage their risk factors or disease Referral and Follow-Up Help those at risk for having CHF or those with CHF from the community be able to access the resources provided previously Keep tabs on patients identified for being at risk or having CHF to prevent problems or resolve problems or concerns (Stanhope & Lancaster, 2012)

Plan of Action Case Management Locate resources, places in the community, or systems that provide the necessary services the at risk elderly CHF patients need Optimize self-care capabilities and help those who are unable to perform self-care with resources that can help them such as home health nurse, home oxygen, mobility supplies, meal on wheels, ect. Delegated Functions Nurse works under the authority of a physician to directly care for the at risk population The nurse can perform lab draws, giving medications, and assessing the patient The nurse can delegate other tasks to appropriate personnel to care for the patient such as performing an EKG, checking vital signs, and weighing patient (Stanhope & Lancaster, 2012)

Plan of Action Health Teaching See how much knowledge a patient has about their risks and condition prior to performing teaching See what questions that patient has about their condition Start teaching with weight monitoring by using the same scale, at the same time, with same type of clothes everyday Teach about reporting a weight gain of >3 lbs in one day or > 5 lbs in one week Teach the patient about their medications such has diuretics, BP medications, potassium supplements, and electrolyte monitoring Assess the patient’s current activity level and see if they are a candidate for home physical therapy A cardiac rehabilitation program may be helpful for the patient The patient may need to see a dietician for dietary education Instruct the patient to avoid fats, fried foods, foods with >400 grams of sodium Do not eat more than 2 grams of salt per day Consult with physician about alcohol consumption Eat foods to keep BP and DM under control

Plan of Action Counseling Establish relationship with the elderly population at risk for CHF, the community, families of the patients, and individual patients Engages the community and population on an emotional level Assessing how well the at risk population copes with their risks, conditions, and life style changes Consultation Sees at risk patients for not only their CHF problem, but sees them as having other comorbidities such as diabetes, hypertension, thyroid problems, ect. Receives information from reports and the patient seeks more information about the comorbidities in order to problem solve through the issues

Plan of Action Collaboration Advance practice nurse will work with a cardiologist, primary care physician, other community health workers, the patient, and the patient’s family to reach one final goal Coalition Building Joins alliances with organizations such as The American Heart Association, community health department, other medical clinics, and community hospitals to serve a common purpose for the elderly population at risk for CHF Address concerns about CHF risks to community leadership

Plan of Action Community Organizing Work with community groups to figure out potential goals for the patients, how to access resources, and how to reach the patient’s goals for the community Advocacy Stand up for the elderly population’s risk for CHF Get the community involved in this population’s cause and the importance of monitoring their heart function Speaking up for the patient’s needs and finding a way to meet their needs

Plan of Action Social Marketing Using technology such as television, internet, social media, texting, or telephone calls to promote the cause Making advertisements such as in pamphlets, magazines, and billboards around the community Policy Development Going to government officials and health administrators for decisions to be made to promote optimal health for the at risk population Allowing leadership to make decisions about rules, laws, regulations, ordinances, and policies for the cause Policy Enforcement Leadership requires others in the community to obey the policies they developed (Stanhope & Lancaster, 2012)

Evaluation of Worth of Action To evaluate the worth of action of the plan using the Intervention Wheel, the process starts with following up with the elderly patients being identified as at risk or having CHF This can be done by seeing patients in a clinic setting, looking up health information from the patient’s records, or performing follow-up surverys over the phone The APN will ask questions when following up about: Weight gain/weight loss Taking medications Shortness of breath Mobility

Evaluation With performing all the evaluation actions, the APN will be able to meet all of her goals for her plan of action of creating a CHF program for the elderly population

Advantages for Using the Theory The Intervention Wheel was created to make visible the public health interventions at the community, system, and indidual/family level It helps identify the core functions of the advanced practice nurse in the community setting The borrowed theory is a holistic approach to helping different populations and their problems (Mc. Donald, Frazer, ect. , 2015)

Disadvantages of the Theory There a lot of steps to go through in order to use this theory Being able to meet all the steps as a public health nurse with other’s help such as collaborating, coalition building, community organizing, policy development, and policy enforcement Being able to find funds to do such steps as social marketing, outreach, screening, and case management

Conclusion In conclusion, the concepts and steps for the Public Health Invervention Wheel are detailed and if followed correctly can decrease the prevalence of CHF within the elderly population in a community. Providing eduation about the disease and providing community outreach to this population can go a long way in completing all the steps of the borrowed theory.

Discussion Questions What other goals of the action plan could the APN have when using the Public Health Intervention Wheel for creating a CHF prevention program in the elderly population? In what ways could the APN provide community outreach for the elderly population in regards to preventing or controlling CHF? How can the APN follow-up with the elderly population patients about preventing or controlling their CHF?

References BMJ Publishing Group. (2010, July 14). Investigation and Management of Congestive Heart Failure. Retrieved from http: //www. bmj. com/content/341/bmj. c 3657 Keller, L. O. , Strohschein, S. , Lia-Hoagberg, B. , & Schaffer, M. A. (n. d. ). Population-based public health interventions: practice-based and evidence-supported. Part I. - Pub. Med - NCBI. Retrieved from http: //www. ncbi. nlm. nih. gov/pubmed/15363026 Lippincott Nursing Center. (2009, September). Heart Failure: Educating Your Patient Can Help Prevent Readmission. Retrieved from http: //www. nursingcenter. com/journalarticle? Article_ID=940643 Mc. Donald, A. , Frazer, K. , Duignan, C. , Healy, M. , Irving, A. , Marteinsson, P. , … Molloy, B. (2015, March 20). Validating the 'Intervention Wheel' in the Context of Irish Public Health Nursing. Retrieved from http: //www. ncbi. nlm. nih. gov/pubmed/25754782 Minnesota Department of Health. (n. d. ). Public Health Interventions. Retrieved from http: //www. health. state. mn. us/divs/opi/cd/phn/docs/0301 wheel_manual. pdf National Heart, Lung, and Blood Institute. (2016, February 26). Community Surveillance of Congestive Heart Failure. Retrieved from https: //clinicaltrials. gov/ct 2/show/NCT 00005517 Stanhope, M. , & Lancaster, J. (2012). Public Health Nursing: Population-Centered Health Care in the Community (8 th ed. ). Maryland Heights, MI: Mosby Elsevier. Wisconsin Department of Health Services. (2015, April 30). Wheel Manual - Public Health Practice Section. Retrieved from http: //www. health. state. mn. us/divs/opi/cd/phn/wheel. html