Systems-focused population-based Public Health Nursing practice: Addressing pandemic flu

Public health experts, research, and nursing theory identify the importance of systems-focused assessment, planning, intervention, and evaluation as essential components of population-focused PHN practice. Evaluation of public health nursing competency reveals that of the three focus areas of practice (individual, community, systems), PHNs rate themselves least competent in systems-focused practice. Systems-focused practice is directed toward changing organizations, policies, laws and power structures. The purpose of this presentation is to describe systems-focused public health nursing practice in relation to pandemic flu preparation.

Utilizing the community assessment process, health issues in the community are identified and prioritized, such as the risk of pandemic flu. This process leads to issue specific assessment conducted at individual/family, community, and systems levels. The systems-focused issue specific assessment involves identifying systems/organizations needed to address the identified health issue. Systems representatives are invited to partner in issue specific planning. Systems representatives share information about their system including organization, laws, policies, history, boundaries, environment, and relationship changes over time, specifically as they may affect pandemic flu prevention. This information is used to identify system issues to be addressed in the systems plan directed toward interventions promoting pandemic flu prevention. The plan also addresses the need to coordinate systems planning with individual/family and community planning activities.

Systems-focused interventions related to pandemic flu may include changing quarantine laws and organizational sharing policies, training of health/safety personnel, as well as testing mass dispensing plans. Implementing systems change is complex given the dynamic nature of most systems and the forces that promote and or resist systems change. Interventions directed toward change both within and among systems necessitate close coordination and frequent communication with other parts of the system.

Short and long term process, structure and outcome evaluation is critical in systems-focused practice. Such evaluation helps to determine if the planned implementation has unintended consequences, an example of which might be the influence of quarantine law changes on other communicable diseases such as HIV. Recommendations to strengthen population focused systems public health nursing practice include further clarification of systems practice, research on the effectiveness of systems interventions, and development of systems education strategies.