NUR 306 Module 1 Short Paper Example

One Nurse, Three Towns and a Harbor: The Public Health Nursing Role Through the Intervention Wheel

[Student Name]

Southern New Hampshire University

NUR 306: Nursing in the Community

Module One Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

One Nurse, Three Towns and a Harbor: The Public Health Nursing Role Through the Intervention Wheel

In a hospital, a nurse's work is organized around patients who have already arrived. In a small coastal town, the public health nurse has to decide which people the work is for, where to find them and what kind of help will reach them before they become patients. This paper describes the public health nursing role in a composite Maine lobstering town, here called Pell Harbor, using the Public Health Intervention Wheel developed by the Minnesota Department of Health and validated through a national review (Keller et al., 2004). The paper argues that the role is defined less by the tasks the nurse performs than by the level at which each task is aimed, and that the most important work in a harbor town happens at the community and systems levels, where one nurse can reach hundreds of people at once.

The Setting

Pell Harbor has about 2,800 year-round residents, a population that nearly doubles in summer. Its economy rests on lobstering, with a fishermen's cooperative on the town wharf, a boatyard and a few restaurants. The nearest hospital is 35 minutes away by road, and a small federally qualified health center operates two days a week in town. The public health nurse is employed by a regional district and divides her week among Pell Harbor and two inland towns. Her caseload includes communicable disease follow-up, immunization clinics, home visits to new parents and older adults, school consultation and emergency preparedness. The town, its population and its services are composites based on small coastal communities in the region.

The Intervention Wheel as a Lens

Keller et al. (2004) describe the Intervention Wheel as a population-based practice model with 17 public health interventions, such as surveillance, outreach, screening, case finding, health teaching, collaboration, coalition building, advocacy, social marketing and policy development, and each of them can be aimed at one of three practice levels. Work aimed at individuals and families tries to change what particular people know, believe or do. The community level aims at a whole population or group. The systems level changes organizations, policies and the structures that shape health. Population-based practice, in their definition, focuses on entire populations, considers the broad determinants of health and emphasizes prevention at every level. The model is useful here because it forces a question that job descriptions skip: for any task, who is it actually meant to change?

The Role at the Individual and Family Level

Much of the nurse's week looks familiar to an acute care nurse. She visits a new mother whose partner is at sea for three days at a time, follows up on a case of salmonellosis reported by a laboratory and checks on an older fisherman recovering at home after a shoulder injury. These are individual and family interventions: case management, referral and follow-up, health teaching and counseling. They matter, and in a town without a daily clinic they may be the only nursing care some families receive. But at this level, the nurse's reach is limited by the number of hours in a week, and the problems she sees at kitchen tables often repeat from house to house.

The Role at the Community Level

The repetition is the reason community-level work exists. Commercial fishing is one of the most dangerous occupations in the country, with a 2016 fatality rate of 86.0 deaths per 100,000 full-time workers compared with 3.6 for all workers, and falls overboard are its second leading cause of death (Case et al., 2018). The nurse cannot visit every crew. She can, however, work with the cooperative to run a spring health day on the wharf, offering blood pressure screening, tetanus boosters and a short talk on cold water survival while crews are rigging their boats. That event uses screening, outreach and health teaching aimed at a population defined by shared work. The same logic applies when she partners with the elementary school on vaccination rates or with the church on a caregiver support group for families of people with dementia.

The Role at the Systems Level

The systems level is where one nurse can change the conditions that produce the repeated problems. In Pell Harbor, that might mean sitting on the harbor committee when it revises wharf safety rules, joining the regional coalition that is expanding access to treatment for opioid use disorder, or advocating with the district for a second clinic day in summer, when the population doubles. These are coalition building, advocacy and policy development. They are slow and often invisible, and they rarely appear in a job description. Yet the national list of ten essential services, updated in 2020 to put equity in the middle of the model, treats exactly this kind of work, building policies and partnerships that support health, as a core responsibility of public health practice (Castrucci, 2021).

Comparison With Acute Care Nursing

The differences between this role and hospital nursing are not only about setting. In acute care, the nurse's priorities come from the patient's condition and the physician's orders. In Pell Harbor, the nurse must set priorities herself, using data about the population, and she must justify the time she spends on a coalition meeting rather than a home visit. Her outcomes are measured in rates, such as vaccination coverage or injuries per season, rather than in one patient's recovery. The skills overlap, including assessment, teaching and advocacy, but the unit of care changes from the person to the population, and that change reshapes every decision.

Conclusion

A job description would describe the Pell Harbor nurse as a public health nurse who performs home visits, clinics and disease follow-up. The Intervention Wheel describes her as a nurse who works at three levels at once and whose greatest reach comes from the community and systems work that no list of tasks captures. For a town built around one of the most dangerous occupations in the country, that reach may be the most valuable thing a single nurse can offer.

References

Case, S. L., Lincoln, J. M., & Lucas, D. L. (2018). Fatal falls overboard in commercial fishing: United States, 2000-2016. Morbidity and Mortality Weekly Report, 67(16), 465-469. https://doi.org/10.15585/mmwr.mm6716a2

Castrucci, B. C. (2021). The "10 essential public health services" is the common framework needed to communicate about public health. American Journal of Public Health, 111(4), 598-599. https://doi.org/10.2105/AJPH.2021.306189

Keller, L. O., Strohschein, S., Lia-Hoagberg, B., & Schaffer, M. A. (2004). Population-based public health interventions: Practice-based and evidence-supported. Part I. Public Health Nursing, 21(5), 453-468. https://doi.org/10.1111/j.0737-1209.2004.21509.x