Although population health and population health management have received growing attention in the health care industry over the past decade, its origins in nursing is not new. Nightingale recognized the role that point-of-care nurses played in caring for individual patients and their families. Yet, on further analysis, Nightingale had a keen interest in, for instance, the population of soldiers that she and her nurses were called to care for in the Crimean War. Using her knowledge of statistics, she constructed epidemiologic models to discover interventions to care for the population, strategies that led to a reduction in morbidity and mortality. Training and education of nurses—key to the professional development educator today—requires the use of population science.
Population health and population health management originated in Canada in 1997 and its use in U.S. health care was advanced with the Patient Protection and Affordable Care Act. Another factor that advanced population health was the advent of electronic health records in multiple clinical settings capturing, and then analyzing, aggregated data with computational power and speed that had never existed (Wilson, Weaver, Procter, & Beene, 2018). The Canadians were interested in measuring health status indicators as influenced by social, economic, and physical environments, personal health practices, individual capacity and coping skills, human biology, and early childhood development (Public Health Agency of Canada, 2013). Although the United States focused on the medical model in a nonsynchronized health system, the Canadian model was unified beyond primary, acute, and specialist-driven care to include social determinants of health with a broader view of the factors that led to health and well-being.
Social determinants of health are the conditions in which people are born, grow, live, work, and age. They include economic stability, the neighborhood and physical environment, education, food, community and social context, and the health care system (Artiga & Hinton, 2018). Leaders in health care design, reimbursement, science, education, and more now embrace population health with increased fervor as the political spotlight has increased American attention on quality of life and cost reduction in medical care.
Professional Development Educator Role
In recent discussions, it has become even clearer that population health requires professional development educators to lead and invite learning through the lens of population health. Traditional approaches to education have focused on cognitive, skill, discipline-based socialization, communication, and moral/ethical development in learner evaluation. The aim to prepare individuals for caregiving roles, predominantly in acute care, has started to shift into transitional and community-based options as jobs in those settings grow. Point-of-care critical thinking has been emphasized. Interventions have been oriented to individuals and families with heavy emphasis on charting data (needed for assessment and evaluation), procedures and techniques, and interaction with various technologies. The expectation to perform effectively on a team and show self-confidence in handling conflict is layered onto an expectation that patient-centered care will be delivered in a safe and quality manner.
The professional development educator commonly works with nursing school faculty and plays a key role as new nurses acclimate to their first professional roles. The desire for nurses to be practice ready is a daunting expectation given the complex nature of professional practice environments. Even highly skilled and confident nurses in caregiving must still learn the intricacies of how care teams function, how to navigate the systems and processes used to deliver care (and whether they work), and how to meet expectations often associated with a unit-based or specialty culture. For this and other reasons, residency programs offer time for organizational acclimation beyond what is plausible in an academic setting.
As used in nursing, population-based care can have multiple definitions. A population might include those covered by a particular type of insurance, such as Medicare®, or may be geographically defined, such as those residing in a neighborhood or a region (i.e., rural settings). Further delineations include age groups, such as neonates. Most commonly, nurses define populations by disease conditions, such as those with breast cancer or heart failure, and by ethnic, socioeconomic, religious, cultural, or even employment groups. Within each lens, common health and illness factors influence approaches to care. There is a tension between population-based awareness of patterns that exist, from which care is standardized and interventions are formulated, and patient-centered care, which suggests that everyone is unique and needs tailored care. Both are true, and the professional development educator shapes how clinical leadership and care management uses population-based science to generate effective and efficient standardized approaches to care, while tailoring care sensitive to individual care.
Where Population Perspectives Matter Most
Beyond nursing knowledge of individual medical diagnoses and treatment regimens, concept-based care encourages nurses to examine clinical problems experienced across patient populations. When educators guide learners to examine approaches, for example, in pain management, rote learning is replaced with pattern recognition and knowledge transfer to others experiencing pain. Pattern recognition accelerates efficiency and effectiveness in clinical practice.
Population health—the pattern recognition ability of a nurse—aids in nursing assessment, discharge planning and care transition to and from health care settings, and health promotion and disease prevention strategies developed for cost-effective population consumption and application, as well as for quality improvement. Professional development educators can guide the development of population-based pattern recognition, including those that are cross-cutting. For instance, in examining the effectiveness of nursing's contribution to pain management, the approach to evaluating the effect can be on a case-by-case basis, or a population perspective can be used from which a series of cross-cutting population factors can be considered:
- Is pain equitably managed in infants and children or in older adults?
- Is pain equitably managed across socioeconomic groups?
- Is pain equitably managed with consideration to race or culture?
Each question represents a new way of framing inclusive care management and will yield confidence in care delivery across populations. Results will yield training and development opportunities that may otherwise be missed.
Similarly, those who hold positional roles as leaders and managers require competencies in acquiring and using population health management perspectives in organizational decision making. The combined ability—to use knowledge, skills, and abilities to provide individual care with the ability to examine patterns that emerge from the context of social determinants of health—is a prescription for elevating the quality of care given and possible to achieve.
It is time to call out the applied use of population health perspectives in all aspects of nursing education. We can ensure that all nurses have the critical thinking skills needed to tailor individual care within a larger context of population health. Population health includes opportunities for individualized care, but also promotes interventions and evaluation that encompasses cohorts of individual who share common health conditions and are the products of social determinants of health. In health science, discoveries have traditionally been generalized to populations; new emphasis is now on personalized medicine. In education and practice, tradition has held to a focus on individualized care; new emphasis is on adding a population perspective to care delivery.
- Artiga, S. & Hinton, E. (2018). Beyond health care: The role of social determinants in promoting health and health equity. Retrieved from https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/
- Public Health Agency of Canada. (2013). What is the population health approach? Retrieved from www.phac-aspc.gc.ca/ph-sp/approach-approche/appr-eng.php
- Wilson, M.L., Weaver, C.A., Procter, P.M. & Beene, M.S. (2018). Big data in health-care: A wide look at a broad subject. In Delaney, C.W., Weaver, C.A., Warren, J.J., Clancy, T.R. & Simpson, R.L. (Eds.),Big data-enabled nursing: Education, research and practice (pp. 460–464). Cham, Switzerland: Springer.